Repairing the Healthcare Systemtag:typepad.com,2003:weblog-3529232017-08-09T13:08:39-05:00TypePadRepairingTheHealthcareSystemhttps://feedburner.google.comWhat Was John McCain Thinking?tag:typepad.com,2003:post-6a00d83451876469e201b8d29e7faa970c2017-08-09T13:08:39-05:002017-08-09T13:12:11-05:00Stanley Feld M.D., FACP, MACE I remember when President Obama held a meeting in 2009 with congressional Republicans in the House and Senate to discuss Obamacare before its passage. This was to get input from Republicans before the Democrats excluded...stanleyfeldmdmace

Stanley Feld M.D., FACP, MACE

I remember when President Obama held a meeting in 2009 with congressional Republicans in the House and Senate to discuss Obamacare before its passage.

This was to get input from Republicans before the Democrats excluded Republican input and were ready to vote in their Democratic Party dominated house and senate.

John McCain offered a constructive comment to improve Obamacare. President Obama’s response was “John I won the election.”

Now that Obamacare is an unmitigated failure John McCain voted against a simple repeal of Obamacare.

John McCain ran for reelection in his Senate primary and again in the general election on the platform that he would repeal and replace Obamacare.

“I think it’s a very strong issue,” McCain told POLITICO about his focus on Obamacare. “Eight of the counties in my state will now only have one [health insurer]. They’re looking at 65 percent increases in their premiums. They’re very upset.”

Why did he vote against the simple repeal? Is he a political hypocrite?

Does he hate President Trump so much that he will do anything to undermine his agenda?

Paul Ryan’s original bill allowed for an easy transition from Obamacare to a replacement bill.

Congressional leaders, especially John McCain, must listen to this lecture.

The traditional media critiques should listen to Paul Ryan’s lecture carefully and report on it fairly.

His plan would eliminate many of the Obamacare punitive regulations and permit Health Savings Accounts to grow. It would stabilize the health insurance markets. Some Republicans in the House are still opposed to his bill. They wanted immediate repeal and replace. They could not comprehend Paul Ryan’s subtle strategy.

Speaker Ryan finally got a watered down version of his proposal passed and ready for a joint conference. The Democrats fought it all the way.

In the senate, the Democrats said no to any proposal President Trump supported.

Both Chuck Schumer and Nancy Pelosi said it is the Democrats job to say no to everything in President Trump’s agenda. The job in their view is to destroy the Trump presidency.

Their plan is to destroy the Trump presidency with the help of the traditional media and the deep state. The deep state consists of Obama administration holdovers and anti-Trumpers in administrative positions. Some are career administrators. It is becoming obvious that they are also the leakers.

Chuck Schumer has done everything in his power to slow down confirming President Trump’s nominees. He has openly admitted this.

The members of the deep state have been leaking classified information to the press about President Trump’s administration. These are federal crimes. Secretary Sessions is starting to do something about catching these leakers.

President Trump has pledged to clean up the swamp. The swamp consists of the deep state plus many Democrats and some Republicans are both houses.

President Trump has the ability to confirm his nominees when both houses in congress are in recess.

By a strange sounding rule, both houses of congress can be considered in session when all the congresspersons are in recess.

Lisa Murkowski (R Alaska) set it up so that while the senate is in recess it is still in session. This is denying President Trump the opportunity to make recess appointments.

Senator McConnell did not do anything to stop her. It looks like the Republican establishment is also trying to destroy President Trump’s presidency.

Why would I think that?

President Trump has not had any cooperation from the Republican establishment to date.

President Trump pledged to clean up the swamp. All of the parties mentioned are the swamp that has hampered the growth of our economy.

I guess John McCain did his job for both the Democratic and Republican political establishment by voting against the simple repeal of Obamacare.

“The Senate GOP’s healthcare bill failure is a political debacle that will compound for years, and the first predictable fallout is already here:

“Republicans in Congress are under pressure to bail out the Obama Care exchanges, even as Donald Trump threatens to let them collapse.

The GOP needs to get at least some reform in return if it’s going to save Democrats and insurers from their own failed policies.”

“Mr. Schumer may figure he can bludgeon the GOP into surrender because his press-corps buddies will blame the GOP for rising premiums.”

Let’s see what happens as a result of the swamp’s victory.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/08/what-was-john-mccain-thinking.htmlA Single Party Payer System Will Not Worktag:typepad.com,2003:post-6a00d83451876469e201b8d29c3fb6970c2017-08-02T17:49:28-05:002017-08-02T23:55:44-05:00Stanley Feld M.D.,FACP, MACE Why am I opposed to a single party payer healthcare system? I am concerned about America’s $20 trillion dollar deficit and $180 trillion in unfunded liabilities. I am also concerned about China being a reliable buyer...stanleyfeldmdmace

I am also concerned about China being a reliable buyer of American debt.

The deficit should be viewed as a house of cards that might crumble at any time.

Our country has suffered a massive increase in the deficit the last eight years under Barack Obama and Obamacare. The public knows the debt has increased at lease 1 trillion dollars a year.

No one has seen a good accounting the deficit increase. Everyone knows we have had massive inflation even though we have been told that inflation is only one percent.

The public knows Obamacare is imploding.

The public knows about the waste incurred during the Obamacare website roll out and the scandalous contracts to venders. The public knows about the massive increasing in insurance premiums and the massive subsides that were not anticipated.

The Democrats that the people have elected to congress do not seem to care about the deficits created. Now, we have finally realized that the Establishment Republicans do not seem to care about Obamacare failures either.

These officials do not care how much money the government wastes on bad deals at all levels of the economy. Obamacare has made terrible deals with the insurance industry, the pharmaceutical industry and hospital systems.

It has not made a good deal for the middle class or their primary providers namely physicians.

I do not think American healthcare policy makers or congress can afford to make another mistake.

Winston Churchill’s famous quote about Americans stands out here.

“You can always count on Americans to do the right thing after they’ve tried everything else.”

America cannot try something that is destined to fail. Socialism, especially in healthcare, does not work. Our government officials refuse to believe this even though it is demonstrated by our own failed entitlements such as the VA Healthcare System, Medicare and Medicaid.

Government officials refuse to believe that the socialistic universal healthcare systems in the rest of the world are unsustainable.

So I find it a bit ironic that seven months after losing the 2016 presidential election, Schumer feels the Democratic Party is still struggling to articulate a coherent message. Meanwhile, the Bernie Sanders-Elizabeth Warren wing of the party delivers a very clear message. Unfortunately for their constituency, it's about a failed ideology — socialism.

While socialism is antithetical to the ideals of the Founding Fathers, it tends to gain its strongest support among the young and those who are uninformed. On the surface, socialism sounds great; it has always sounded great and will continue to sound great within certain precincts. The only problem with socialism is that history exposes it as a bankrupt ideology.

But rather than describing socialism's failures tenet by tenet, the following apocryphal story illustrates socialism's inherent defects in an easy-to-understand way.

An economics professor at a local college made a statement that he had never failed a single student before but had once failed an entire class. The class insisted that wealth redistribution, aka socialism, worked because then no one would be poor and no one would be rich — a great equalizer.

The professor then said, "OK, let's try an experiment." Henceforth, all grades would be averaged; everyone would receive the same grade, and no one would fail.

After the first test, the grades were averaged and everyone received a B. The students who studied hard were upset but the students who studied little were happy. As the second test rolled around, the students who had studied little now studied even less and the ones who studied hard decided they wanted a free ride, too, so they too decided to study little. The second test average was a D.

Now no one was happy. When the third test rolled around, the class average was an F; and from that point forward, the scores never increased, as bickering, blame and name-calling all resulted in hard feelings with the result that no one would study for the benefit of anyone else and the students all failed the class.

The professor then told them socialism as a form of government always fails because of human nature, i.e., when the reward is great, the effort to succeed is great, but when government takes the rewards away, no one will try to succeed.

HUMAN NATURE IS PART OF IDEOLOGICAL EQUATIONS

Similar to the aforementioned students, the far left consistently overlooks the fact that human nature is part of any ideological equation. They fail to understand that socialism has never and will never work because it's based on a premise that's inconsistent with human behavior.

When people work, they expect to be compensated commensurate with their effort and skill level. And capitalism does that more effectively than any economic system yet devised by man. Capitalism provides an incentive for people to achieve because they know their efforts will be rewarded.

Conversely, socialism is a disincentive to achievement because people also know their work is valued only collectively, rather than being valued individually.

Quote of the day: "The inherent vice of capitalism is the unequal sharing of blessings; the inherent vice of socialism is the equal sharing of miseries." — Winston Churchill.”

Butch Mazzuca, of Edwards, writes regularly for the Vail Daily. He can be reached at bmazz68@comcast.net.

Our politicians should stop fooling around with America’s healthcare system, our fiscal viability, and the welfare of our citizen.

It is time to try something that will work, and not another thing that is doomed to failure.

Elizabeth Warren and Bernie Sanders, you are both dead wrong.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/08/a-single-party-payer-system-will-not-work.htmlThey Are Getting There tag:typepad.com,2003:post-6a00d83451876469e201b8d299fcc3970c2017-07-26T21:17:36-05:002017-07-26T21:17:36-05:00Stanley Feld M.D.,FACP, MACE As Obamacare implodes, President Trump is trying to get a Republican congress to repeal and replace Obamacare in an orderly fashion with a minimum of disruption to the present healthcare system. The Republican establishment in congress...stanleyfeldmdmace

Stanley Feld M.D.,FACP, MACE

As Obamacare implodes, President Trump is trying to get a Republican congress to repeal and replace Obamacare in an orderly fashion with a minimum of disruption to the present healthcare system.

The Republican establishment in congress is trying to disrupt his goal. All the Democrats are going to stonewall him.

Republicans won both houses of congress because they promised to repeal and replace Obamacare. They had seven years to create a plan. They have failed to achieve a consensus in the Republican caucus.

Democrats are starting to talk about making it easy. They are suggesting congress replacing Obamacare with a government run single party payer healthcare system.

You may recall President Obama told John Kerry and Barney Frank that America would get to a single party healthcare system via Obamacare. He told them not to worry.

The reality of the situation is America is inching its way to a universal single party payer healthcare system.

Medicaid, Medicare and the VA system are already single party payer systems. Each one of these programs has been declared unsustainable.

It is incomprehensible to me that the Republican politicians who the American people elected in good faith are not hearing their complaints

Presently 41.5% of the population is in one of these single party payer healthcare plans. 49% of Americans pay no taxes. This means that 51% of Americans are paying the healthcare bill for 49% who do not pay taxes.

This is the redistribution of wealth that Dr. Donald Berwick said was essential in America.

If fact many of the 49% receive additional monies from the government such as food stamps, free mobile telephone service and free housing.

America is on its way to European socialism, This ideological system has failed in Europe.

The following calculation is how I came up with the percentage of Americans that are in an entitlement healthcare system. I use U.S. agency census data.

The chart below displays the total number of individuals enrolled in Medicaid and the Children's Health Insurance Program (CHIP) in the current month (April 2017) and the period prior to the start of first Marketplace open enrollment period or “baseline” period (July – Sept. 2013).

The current enrollment is obviously post Obamacare.

Month

Expansion States

Non-Expansion States

Total

Baseline July-Sept 2013 (Monthly Average) (49 states)

37,069,415

19,733,676

56,803,091

Apr 2017 (preliminary) (51 states)

52,058,495

22,472,507

74,531,002

Medicaid and Chip increased by 22,472,507 since the onset September 2013.

74,531,002/326,613,397 equals 22.81% of the population is on Medicaid so far.

Medicare enrollment is lower than present Medicaid enrollment. As of May 2017, 37,976,052 are on original Medicare and 20,089,220 are on Medicare Advantage or others Medicare plans for a total of 58,065,272 on this single party payer entitlement.

Medicare is an entitlement program with high premiums. The premiums are means tested. People in the upper tax brackets pay over $18,000 a year in after tax dollars premiums for Part B, Part D and Part F.

The people in lower tax brackets pay less. The premium deduction for Part B is taken out of their monthly Social Security check. This creates a burden on their standard of living.

The additional 58,065,272 to the 74,531,002 bring the total percentage of the population on a single payer healthcare system to 40.6%.

(132,596,274/326,613,397= 40.6%)

If the VA healthcare system enrollees are added to the analysis of the number enrollees to a government run single party payer healthcare system the percentages increase.

In Fiscal Year 2014 the total veteran population was 21,619,731. 9,111,955 veterans were enrolled. 6,616,963 veterans used the VA Hospital System. The VA System brings the total number enrollees in a single party payer system to 133,508,229 or 40.9%

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/07/they-are-getting-there-.htmlThe Republican Establishment’s Failuretag:typepad.com,2003:post-6a00d83451876469e201b7c90da3b0970b2017-07-20T16:34:59-05:002017-07-20T16:34:59-05:00Stanley Feld M.D.,FACP, MACE I am coming to the conclusion that the Republican establishment does not want to Repair the Healthcare System. The Republican establishment has the same goal as the Democratic establishment. Recently the mainstream media is saying that...stanleyfeldmdmace

Stanley Feld M.D.,FACP, MACE

I am coming to the conclusion that the Republican establishment does not want to Repair the Healthcare System.

The Republican establishment has the same goal as the Democratic establishment.

Recently the mainstream media is saying that a single party payer system is looking good.

Neither party has any interest is having consumers control their healthcare dollars. It looks as if both parties want the government to control the consumer’s healthcare dollars.

All the politicians ignore the fact that government control is unaffordable. It also ends up not working.

The best example is the bureaucratic VA Hospital System and its system wide corruption.

“How are patients supposed to be responsible for their healthcare dollars when there is absolutely no transparency and no consistency in pricing.”

The lack of transparency is a major defect in our present healthcare system.

Only 20% of consumers use the healthcare system at any one time. Eighty percent of the consumers have not run into the lack of transparency problem in the healthcare system.

Most consumers do not care about transparency because they have first dollar coverage provided by their employer. They think their medical care is free. They believe they have excellent healthcare insurance.

President Obama took care of that notion with Obamacare. The defective structure of Obamacare caused healthcare insurance premiums and deductibles to skyrocket. First dollar healthcare insurance became too expensive for most employers.

Employers stopped providing first dollar coverage. Middle class employees are now noticing that out of pocket expenses have made their healthcare insurance unaffordable. Consumers have tried to compare prices of competitive providers. They have discovered that it is impossible!

Consumers are becoming aware of the lack of transparency. They have been astonished by this lack of transparency.

There is nothing in the new Republican bill that addresses Republican politicians’ awareness that the lack of transparency is a major defect in the healthcare system.

The lack of transparency is only one of the major defects in our healthcare system.

There is nothing in the Republican bill that speaks to the consumers’ responsibility for their health and healthcare dollars. Consumer driven healthcare is completely ignored.

There is nothing in the bill that addresses effective tort reform. The Massachusetts Medical Society survey showed that defensive testing to avoid lawsuits costs the healthcare system between $250 billion to $700 billion dollars a year.

The lack of the development of systems of care for chronic diseases cost another $700 billion dollars a year that our healthcare system does not address. There is nothing in the bill that emphasizes this very important defect in the healthcare system.

The Republican establishment thinks consumers are too stupid to take care of themselves.

The mainstream media likes to tell us that people love entitlements. The public does not want to give up these entitlements.

My question is how come less than 9 million people signed up for Obamacare’s individual healthcare plans last year if they love entitlements?

It is because they cannot afford to buy the health exchange insurance even though 85% of the premiums of those 9 million consumers are subsided by the government. Their high deductibles are not subsidized.

The Republicans are going claim they are promoting health savings accounts. The public is not told the amount of money they can put into a health savings account or whether it will provide first dollar coverage over that amount if they get sick.

There is no financial incentive for consumers to be responsible for their healthcare or their healthcare dollars.

My Ideal Medical Saving Account is a much better idea.

These are only a few of the major defects in the Republican establishment’s concept to fix the healthcare system.

President Obama did some of the awful things to Obamacare through rules and regulations after certain vested interests complained about the law. Obamacare’s rules and regulations have to be eliminated

There were crony waivers that would make one’s blood boil. In fact, elected congressional members got the best exemptions.

It is becoming apparent that congress doesn’t want to fix the healthcare system for the majority of Americans. The congressional establishment wants to control consumers.

Socialism does not work!

Our political establishment does not tell us about the economic result in other countrys’ single party payer universal healthcare systems.

We don’t have to go to other countries. We only have to go to the indigent areas in California were everyone is covered by Medicaid.

The Republican establishment needs to get off the stick before all of them are kicked out of congress.

Just imagine the healthcare systems savings if every consumer were empowered to shop for the best healthcare at the best price.

The result would be a free market healthcare system in which competition would cleanse the system and make it affordable to everyone.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/07/the-republican-establishments-failure.htmlHow Can I Be So Misinterpreted?tag:typepad.com,2003:post-6a00d83451876469e201bb09aeab9b970d2017-07-13T14:52:26-05:002017-07-13T14:52:26-05:00Stanley Feld M.D., FACP, MACE A reader sent me the following comments. “Sorry Doc, I like and Highly respect you, but You are Wrong:  My Ideal Medical Savings Account is essential. OK BUT WHAT ABOUT THOSE THAT LITERALLY LIVE...stanleyfeldmdmace

Stanley Feld M.D., FACP, MACE

A reader sent me the following comments.

“Sorry Doc,

I like and Highly respect you, but You are Wrong:

 My Ideal Medical Savings Account is essential. OK BUT WHAT ABOUT THOSE THAT LITERALLY LIVE PAYCHECK TO PAYCHECK??? How are these Americans going to start and contribute to MEDICAL SAVING ACCT?

Patients must be responsible for their care and healthcare dollars. WHAT ABOUT THOSE CHILDREN AND SENIORS DISABLED----HOW WILL THEY DO SUCH?”

The expansions of entitlements has proven to be unaffordable and ineffective in the past.

In the present Republican healthcare bill to repeal and replace Obamacare people who live from paycheck to paycheck will be eligible for a tax credit that is paid to them in advance. This will allow them to have money to pay for their Medical Saving Account.

If the government subsidizes consumers in this way consumers will not only have the money to pay for their medical care they will also have first dollar coverage above the deductible amount provided by the tax credit.

My Ideal Medical Saving Account convert indigent patients from a complete entitlement program (Medicaid) toward a system where patients would be responsible for their care. Patients would try to conserve their healthcare dollars.

If indigent patients save money on their healthcare coverage they will receive the unspent money in a retirement trust account.

Consumers will have the incentive to stay healthy or be treated appropriately and not overuse the healthcare system. This is the way to My Ideal Medical Savings Account can apply to the indigent and consumers of all income levels.

Essential to Medical Savings Accounts are all prices must be transparent. This is where effective software comes in.

The definition of a tax credit in this context is different than applying a tax credit to income earned. If a consumer is eligible to receive a tax credit he receives the money directly from the government to pay for his Medical Saving Account.

The positive effect to the healthcare system is that if the individuals take good care of themselves and are responsible for their health and healthcare and their healthcare dollars they will not end up in the Emergency Room or hospital and spend a lot of their deductible money.

They will have money left from the tax credit given to them by the government. The money is their money and will go directly into a retirement trust fund. The leftover money is not saved to be spent on future healthcare needs.

This financial incentive will keep the cost down for consumers and the healthcare system.

In the Medicaid entitlement program for the indigent and disabled consumers do not have a financial incentive to be responsible for their health and healthcare dollars. With Medical Savings Accounts there is a financial incentive for consumers to be responsible for their health and healthcare dollars.

“The Ideal Electronic Medical Record is essential. YES BUT SOME CAN BE HACKED SO HOW EFFECTIVE WOULD IT BE?”

When going to a Clinic or hospital consumers automatically sign a consent form for the release of medical records. When buying a healthcare insurance policy consumer sign a similar release of medical records form.

Medical records are not as private as we all would like them to be.

It is the Ideal Electronic Medical Record’s software developer who is responsible for developing medical records that cannot be hacked. Americans have been cautioned about computer privacy since 1980. The problem has not been solved yet.

Most of the electronic medical records that are bought by physician offices and hospital systems are from private vendors. The software is expensive and cannot do everything it is supposed to do including protecting the patient’s privacy rights.

The ideal medical record should provide an educational experience to physicians. Presently the software available does not do this.

The EMRs provide a surveillance tool for the government and the insurance companies to judge patient care.

The government should build an un-hackable software system that resides the cloud. Physicians and hospitals should pay for it by the click. It should provide an educational experience for physicians in order to improve patient care. It should not be used as a punitive tool

We have been told over the years that the VA Hospital System has an excellent EMR. Why is the VA Hospital System switching to Cerner’s EMR? Cerner’s EMR has all the defects of commercial EMRs

Cerner’s EMR is not an Ideal Electronic Medical Record. The company probably obtained the government contract because of its political connections.

“Patient education must be an extension of their physicians’ care. ABSOLUTELY BUT IN ENGLISH NOT MED TERMS!”

This is the reason the healthcare system must be consumer driven with community social networking.

If a physician does not satisfy the community he practices in, consumers will know about it quickly through community social networking. They will then have the choice not to use that physician.

If the government, healthcare insurance companies and physicians will not provide the necessary transparency in the system, consumers must.

“A team approach to chronic disease management must be adopted with the patients becoming the professor of their disease.”

AHH But When a patient Tries to Educate themselves on Such---THE INTERNET HONESTLY HAS CONTRADICTING INFO!

I KNOW THIS ONE PERSONALLY AS I HAVE BEEN RESEARCHING FOODS AND INFO ON HIGH CREATININE LEVELS!

MY CREATININE LEVELS ARE HIGHER THAN NORMAL, but there is so much Contradictory Info out there—

-I.E. Should I EAT UNSALTED NUTS OR NOT EAT NUTS> SHOULD I EAT BLAND WHITE BREADS OR THE MORE HEALTHFUL MULTI GRAIN AND WHEAT BREADS!!! And Should I consume Lean Meats and Poultry or NOT! Some say yes, others say No!

Patients’ cannot educate themselves by solely using the Internet. The educational process has to be through their physician and his healthcare team’s selected Internet sites.

The team should pick the Internet resources it wants the patient to use. The appropriately chosen Internet sites should be used as an extension of the physician’s care. Consumers should be confident of the information source picked by their physician and his healthcare team. It will also enhance the physician patient relationship

“Hence on some of the issues you wrote I slightly agree with, but over all you fail to consider the Poorer Americans and that not all Americans have intelligence to research or are too disabled to RESEARCH!”

I believe that everyone should be responsible for his or her medical care and medical education. Ever the poorest people can be responsible for their care and can be educate.

Many social agencies exist to help poor people be responsible for themselves.

Individual responsibility and initiative is the principle that has made America great. If a person is not capable of being responsible for himself, artificial intelligence systems could be developed to help this very small percentage of the population survive and thrive.

Entitlements and dependence on the central government by all is what President Obama wanted. It simply results in more debt and a weaker society.

There are many problems in society. We have to start somewhere with good ideas to invigorate all levels of society.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/07/how-can-i-be-so-misinterpreted.htmlBetter Care Reconciliation Act (BCRA)tag:typepad.com,2003:post-6a00d83451876469e201b8d2916b30970c2017-06-29T12:42:01-05:002017-06-29T12:42:01-05:00Stanley Feld M.D.,FACP,MACE It looks like the Senate is making a mess out of its version (BCRA) of repeal and replace Obamacare. My first reaction was that Better Care Reconciliation Act is a stupid name for a bill to repeal...stanleyfeldmdmace

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/06/better-care-reconciliation-act-bcra.htmlIt Is All about How You Look At Thingstag:typepad.com,2003:post-6a00d83451876469e201b8d28f1904970c2017-06-22T09:04:09-05:002017-06-22T09:04:09-05:00Stanley Feld M.D.,FACP,MACE Brad Feld responded to my blog “How Software Innovation Can Cause Creative Transformation Of The Dysfunctional Healthcare System”. “Brad Feld” www.feld.com "Brad Feld has been an early stage investor and entrepreneur since 1987. Prior to co-founding Foundry...stanleyfeldmdmace

"Brad Feld has been an early stage investor and entrepreneur since 1987. Prior to co-founding Foundry Group, he co-founded Mobius Venture Capital and, prior to that, founded Intensity Ventures. Brad is also a co-founder of Techstars.

In addition to his investing efforts, Brad is active with several non-profit organizations. He currently is chair of the National Center for Women & Information Technology and the Global EIR Coalition and is on the boards of Path Forward, the Kauffman Fellows, and Defy Ventures.

Brad is a writer and speaker on the topics of venture capital investing and entrepreneurship. He’s written a number of books as part of the Startup Revolution series and writes the blogs Feld Thoughts and Venture Deals.

Brad holds Bachelor of Science and Master of Science degrees in Management Science from the Massachusetts Institute of Technology. Brad is also an art collector and long-distance runner. He has completed 24 marathons as part of his mission to finish a marathon in each of the 50 states."

Brad is an innovative thinker.

This is what he wrote;

“Outstanding blog post dad.

And I think your punch line is completely correct - the healthcare software

innovators should focus 100% of their energy on the patient and the

physician (their customer). That would quickly transform everything in the

healthcare supply chain.

Can you imagine what would happen if the government subsidized Borders

and Barnes and Noble?

Yup - pretty easy to see that they would be doing fine. Bookstores would be classified as a public good.

What nonsense.”

I think common sense, clear thinking and innovative software can solve a lot of the healthcare system’s problems. I don’t think the Senate Republicans are thinking clearly or using common sense in attempting to revise the house healthcare bill.

Healthcare policy makers are trying to reform healthcare by using a business model destined to fail.

The healthcare business model of 1945 to 1965 was a model that put patients and physicians at the center of care. It worked.

In 1965 government policy makers were trying to do a good deed. Their policies started the healthcare system on the slippery slope to destruction.

The government poured money into the healthcare system and patients and physician were no longer at the center of the healthcare system. The secondary stakeholders began to devise ways of taking a large percentage of that government money out to the healthcare system.

They learned to take money that was supposed to be paid for direct patient care out of the healthcare system. In the name of patient care they were permitted by the government to take business expenses off the top.

The relationship between patients and physicians has been destroyed in the process.

The vested interests of secondary stakeholders have taken over and direct healthcare policy. The patients and the physicians are no longer the primary stakeholders in the healthcare system.

The primary customer in the healthcare system should be the patient. Patients’ physicians’ are their primary surrogates.

Well-intended policy makers have tried to fix the system by making revisions and updates to the broken business model.

Their revisions only made the healthcare system more expensive and less effective for the care of patients.

The 2011 Obama business model is a jumble. The secondary stakeholders control the healthcare system. The secondary stakeholders destroyed the patient/physician relationship.

President Obama’s healthcare reform law has made the healthcare system worse than it was pre-Obamacare. Obamacare is a failed business model.

Obamacare does not consider a way to get back to the patient/physician relationship.

It reminds me of the Microsoft operating system. Microsoft has patched upgrades on top of the DOS operating system of the 1980s rather than revising the operating system.

Obamacare has added complexity to the system. It introduced many ideas that have turned out to be bad ideas for the culture that was in place. The execution of these ideas were worse.

One is Accountable Care Organizations. Another is pay for performance rules.

Obamacare does not deal with tort reform. It does not deal with patient responsibility for their own care and their own healthcare dollars.

Obamacare creates a healthcare system that makes consumers more dependent on the government.

Obamacare gives secondary stakeholders (government, the healthcare insurance industry and pharmaceutical companies) increased control over consumers and their freedom to make their own healthcare decisions.

The critical turn in healthcare policy thinking is essential.

The 2020 business model of Obamacare will result in an increase in the velocity of the healthcare system’s collapse.

The result will be an increased budget deficit. Healthcare spending can escalate to 100% of the GDP in less than 20 years.

The business model must be changed. The new business model must be unrestrained by the present business model.

This is where software innovation comes in.

Software must be developed that redirects the model to a consumer driven healthcare system.

It must be controlled by consumer choice, responsibility and actions. Consumers must also control their healthcare dollars. Legislation must be written to provide consumers with choice, responsibility, and incentives to be responsible for their care.

Consumers are the only ones that can demand this option.

Consumers must change the course of the healthcare system.

The secondary stakeholders will not give up their power easily. The release of their power will only come as a result of the Internet and innovative software development that teaches consumers how to utilize their power.

Steve Jobs did it with iTunes, iPods, iPhones and iPad. He transformed the music publishing industry through the use of iTunes.

Jeff Bezo did it with Amazon and the book publishing industry. He has extended his software model to the retailing industry. He is about to extend it to the food distribution industry.

To transform the healthcare system, medicine needs software developers and healthcare policy innovators who understand the practice of medicine.

CEO’s of large corporations and small businesses must think about the future state without government restrictions.

The 2020 medical business model in the future state must have the following components:.

My Ideal Medical Savings Account is essential.

The Ideal Electronic Medical Record is essential.

Patients must be responsible for their care and healthcare dollars.

Patient education must be an extension of their physicians’ care.

A team approach to chronic disease management must be adopted with the patients becoming the professor of their disease.

Patients must become the team leader. Physicians must be coaches with their healthcare team as assistant coaches,

Tort Reform must eliminate defensive medicine,

Specialty care must be integrated with primary care.

All of these components must be attributes of a reformed healthcare system. These attributes must be executed and included in the healthcare system at the same time.

Consumers must be taught to drive the healthcare system.

Skeptics who are trying to hold on to power and protect the validity of past policies will fight hard just as the music industry and the publishing industry did.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/06/it-is-all-about-how-you-look-at-things.htmlSenate Republicans Are Making Repeal and Replace Harder Than It Should Betag:typepad.com,2003:post-6a00d83451876469e201b8d28ccd3b970c2017-06-14T17:34:27-05:002017-06-14T17:36:29-05:00Stanley Feld M.D.,FACP,MACE I think the Republican establishment in the senate is trying to undermine President Trump’s agenda. It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.

It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.

Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.

People like entitlements because they are free. Someone else is paying for them.

Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.

“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.

Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”

The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.

The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.

The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.

President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..

Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.

The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.

Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.

Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.

It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.

They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.

The Republican Party should establish an organized system of disease management education for persons with chronic disease. The education system should be designed to be an extension of physicians’ care. It should not be a free-standing education system. Physicians should be provided with incentives to set up these educational systems.

The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.

Social networking between physicians should also be developed.

Integrated care systems with generalists to specialists must be developed for both treatment and cost transparency for the physicians and patients.

There must be instant communication between physicians and patient via an effective electronic medical record. The EMR must be a teaching tool for physicians. It must not be a tool to judge physicians’ care and penalize them. The EMR should be cloud based. Maintenance and upgrades should be free and seamless. Physicians should be charged by the click.

Tort Reform is an essential element in a healthcare system that would work and be affordable. It would decrease the cost of over testing. It would also decrease the cost of malpractice insurance and legal fees. These cost are built into the cost of care. The cost of care would be reduced significantly. http://stanfeld.com/?s=tort+reform

The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.

Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.

The house bill to repeal and replace Obamacare touches on some alignment.

The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.

The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/06/senate-republicans-are-making-repeal-and-replace-harder-than-it-should-be.htmlIt Looks Like The Dice Are Loadedtag:typepad.com,2003:post-6a00d83451876469e201b8d28a65b0970c2017-06-07T13:07:16-05:002017-06-07T13:07:16-05:00Stanley Feld M.D., FACP, MACE Everyone is probably familiar with Leonard Cohen’s song “Everybody Knows.” If you are not you should read the words and /or listen to it. https://www.google.com/#q=leonard+cohen+song+everybody+knows The first paragraph says it all. “Everybody knows that the...stanleyfeldmdmace

Stanley Feld M.D., FACP, MACE

Everyone is probably familiar with Leonard Cohen’s song “Everybody Knows.” If you are not you should read the words and /or listen to it.

“Everybody knows that the dice are loaded Everybody rolls with their fingers crossed Everybody knows the war is over Everybody knows the good guys lost Everybody knows the fight was fixedThe poor stay poor, the rich get rich That's how it goesEverybody knows”

Leonard Cohen nailed it.

That is what is going on with the repeal and replacement of Obamacare in the congress.

"Everybody knows" the Republicans have shown little enthusiasm in repealing and replacing Obamacare. House Republicans barely got it passed. They had seven years to develop a replacement plan.

I think Republicans do not want replace Obamacare. They have used repeal and replace as a calling card to get a majority in both the house and the senate.

It looks like the American public has been used as a pawn for Republican to gain control of congress.

The Republicans talked a good game for the seven years that Obamacare has been the law of the land.

Obamacare has been a disaster. The majority of people have seen large increases in their healthcare insurance premiums and deductibles along with poor access to care.

Obamacare has cost our treasury trillions of dollars because of it poor business model design and mismanagement.

Obamacare claims it has provided healthcare coverage for twenty million Americans. It is not true. Thirteen million of those twenty million have been added to the enrollees in Medicaid.

Medicaid is a single party payer system that does not provide effective insurance coverage. It does not provide easy access to care in most parts of the country. There is also built in rationing of care.

"Everybody knows"

The healthcare insurance industry insurers are dropping out of Obamacare's health insurance exchanges. Almost all the state insurance exchanges have gone bankrupt and are out of business.

Americans heard over and over again from Republicans that Obamacare is going to die from it own weight. It is true.

There will continue to be insurance to coverage for the nine million insured with preexisting illness. The government mostly subsidizes these nine million patients. However they have unaffordable deductibles.

“Everybody knows that the dice are loaded.”

This week both Mitch McConnell and other Republican senators were publicly pessimistic about their prospects of repealing and replacing Obamacare this year.

“Senate Republicans remain publicly pessimistic about their prospects of repealing and replacing Obamacare this year with several raising concerns this week about the party’s central campaign promise even as one of their leaders vowed to pass such a bill this summer.”

“Mitch McConnell says he can’t see a way to getting 50 votes for the House Obamacare repeal bill?

Now, stop and think here, folks. Back when the only element that we had was the House of Representatives and Republican voters were constantly saying, “Why aren’t you doing more to stop Obama? Why aren’t you trying to do something to stop Obamacare?”

The answer was always, “Well, all we’ve got is the House. W-w-we can’t get anything through the Senate because the Democrats own the Senate. Obama’s in the White House! He’ll veto anything if it did make it there.”

The Republican and Democratic establishment has built a very successful swamp for themselves. It is both socially and economically rewarding. It is a strong powerbase that neither is willing to relinquish.

“ I don’t know what it is. My guess is they don’t want to help Trump.”

President Trump has pledged to drain the swamp. He has pledged to put power back into the hands of the people. He represents a real threat to the power the establishment in both parties has over the people and their freedoms.

Neither party anticipated his victory and neither party understands his popularity. The Democrats are trying to hobble him directly with fake scandals. The mainstream media are trying to hobble him with fake news.

“They just don’t see how they can do it,” Limbaugh said, remarking how especially incredible it is:”

But even in the middle of this I can tell you almost assuredly that Trump is not off his game. He’s not despondent. He’s not sitting there worried about why all these people hate him.

He’s not worried about all that. He’s just head down and moving ahead full speed as he can…

Rush Limbaugh should not be confused. Republicans are defending the swamp they built. These guys are not going to let President Trump disrupt the powerbase that is in the swamp.

While the Republican establishment is stonewalling President Trump, the Democratic establishment is rolling out a single party payer option again. The Democratic establishment is going to try to sneak it in.

The Democrats argue that it is obvious the Republican establishment does not have a plan. The Democrats proclaim they have a replacement for Obamacare. They claim that a single party payer is easy to understand. Their proclamation is, “Doesn’t Medicare work for seniors?”

Medicare does work for seniors. The problem is the premiums and co-payment is becoming higher each year. Supplemental insurance increases each year. Healthcare insurance coverage for seniors is unaffordable to many.

Medicare is also unsustainable for the federal government. The premiums do not cover the costs of coverage.

This is a joke. California has a huge budget deficit presently. Where are they going to pay for its proposal?

When are Democrats going to realize the importance of fiscal responsibility?

They don’t now. The expansion of Obamacare to a Medicare model is unsustainable and will bankrupt the state.

This kind of thinking by liberals and Democrats is not going to repair the healthcare system. It will result in collapse of the healthcare system as politicians try to increase their power over the people.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/06/it-looks-like-the-dice-are-loaded.htmlTrump Is Not the Real Target - You Aretag:typepad.com,2003:post-6a00d83451876469e201bb09a0ff8e970d2017-05-31T14:50:36-05:002017-05-31T14:50:36-05:00Stanley Feld M.D.,FACP,MACP Many of my readers have been upset by the slowness and the lack of progress from the Republican senate in repealing and replacing Obamacare. The country is approaching enrollment time for 2018. Insurance companies need to submit...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACP

Many of my readers have been upset by the slowness and the lack of progress from the Republican senate in repealing and replacing Obamacare.

The country is approaching enrollment time for 2018. Insurance companies need to submit available healthcare plans to the health insurance exchanges soon.

Maybe there will be no healthcare plans available for people in the individual healthcare market with pre-existing illness. This will signify total collapse of Obamacare.

Maybe the Republicans are hanging around waiting for the public to realize that there will be insufficient healthcare plans submitted.

Then the Republicans could blame the Democrats for Obamacare’s failure.

Obamacare has failed for all the reasons I have already written about. There is no reason to debate if it has failed. There is also no reason to debate that President Obama’s vision for Obamacare failed.

President Obama and the Democrats are responsible for its failure. Obamacare was an ill conceived healthcare plan that could not be sustainable.

There are plenty of reasons to support the people who might lose insurance. Those people do not include the 12 million new enrollees in Medicaid.

President Trump is not going to touch their insurance.

The 9 million people enrolled with pre-existing illnesses that have signed up for Obamacare on the individual market must be covered with affordable insurance in some way.

There are many more people in this category who do not have insurance under Obamacare because it is unaffordable.

Within the House Republican plan there are provisions for these people.

It is clear that the liberal mainstream media is on the Democrats’ side.

It’s goal is to do everything it can to obstruct President Trump’s agenda and what he promised the American people.

President Trump won the election on his agenda, not on his personality.

It is clear that the mainstream media is against President Trump. A recent study showed that over 80% of articles written in our daily newspapers are negative articles about the Trump administration.

Many of the 20% positive articles have a negative subtext. Many of these negative articles have no basis in fact and have been proven to be untrue.

President Trump uses the words “fake news” because it angers the press and excites his base.

The Democrats are trying to make as many issues as possible treasonous without any basis for the use of the word treason.

In fact they roll out Maxine Waters every day saying President Trump should be impeached without her presenting a single piece of evidence for impeachment.

President Obama did many things that were unconstitutional. He was never called out for them with congressional investigation. When the issues were investigated they were all given a pass. I can think of the IRS and Lois Lerner investigation, the attorney general issue, the CIA issue, and most of all the Hilliary Clinton hearing in which she said nothing for nine hours. The press, the congress and the President let her get away with it without at least an indictment.

James Comey of the FBI said she was careless and unindictable.

The other day I received the following article from a reader declaring the target of these attacks is not President Trump.

The target is the voters who want constructive legislation in Washington for the people. The country cannot survive with the corruption and unconstitutional behavior much longer.

Tim Daughtry is a conservative speaker and co-author of Waking the Sleeping Giant: How Mainstream Americans Can Beat Liberals at Their Own Game wrote a beautiful article explaining what is going on.

I have never thought of the establishment game in these terms. I have reprinted Mr. Daughtry’s entire article so that all of us will take a moment “to reexamine out premises” as Ayn Ryan suggested 70 years ago in Atlas Shrugged.

“As we watch the daily barrage of accusations and innuendo directed against President Trump by the far left, the liberal media, and even some in his own party, those of us who voted to put him in the Oval Office need to remember one crucial point: President Trump is not the real target. You are.

Even considering his outsized persona and the stunning phenomenon of an outsider who has never held political office winning the presidency against one of the most powerful political machines in American history, the new movement that elected Donald Trump has never been about Trump. In the 2016 election, the “forgotten men and women of America” were hell-bent to send a message to the powerful elites of both parties.

The message was that the Washington elites are serving themselves and their own agenda and ignoring the rest of the nation. The message was that Washington has become a swamp of corruption and self-serving collusion among powerful interests and that Main Street America is ready to see that swamp drained.

Donald Trump was our messenger.

Because his candidacy was not about Trump the man but Trump the messenger, he was able to withstand the smears and assaults of the Clinton Machine that would have sunk any other candidate. They siphoned all the way to the bottom of their slime barrel, and still the message prevailed.

That message was simple and grounded in common sense. No country can survive unless it has control over its borders. People coming into American should be vetted to make sure that they pose no danger to us. After eight years of stifling taxes and regulations, we should once again make America a healthy place in which to do business, make products, and create jobs. Political correctness may seem silly and laughable, but in reality it poses a serious threat to free expression and open exchange of ideas. If it’s terrorism, call it that. Say what is obvious to our common sense even if it offends the delicate sensibilities of the elite.

Now the denizens of the Washington swamp are sending a message back to the forgotten men and women who voted for Trump and his reforms: “Forget you.”

The leftists who worked to radically transform the nation under Barack Obama are telling us that they hold the reins of power and that we the people don’t run anything. They are telling us that their agenda will prevail regardless of how we vote or what we want. They are telling us that they can subvert, attack, and destroy any messenger that we send into their territory. And feckless leaders in the GOP seem, at best, more afraid of displeasing the Democrats than betraying their own voters, and, at worst, in cozy collusion with the opposition.

What is at stake in the barrage of innuendo, twisted news, and “investigations” is not just the future of the Trump presidency, but the future of the very idea that governmental power rests ultimately on the consent of the governed.

Of course there is much at stake in the actual policy questions facing the country. But underneath the debates about border security, court appointees, tax and regulatory policy, and so on lies a deeper question that is at the very heart of our system of government: Can the American people still change the direction of the country if we believe that the country is headed in the wrong direction? Or will the powerful and self-serving elites impose their agenda even when we don’t consent to it?

When the voters put leftists in power, as they did with the election of Barack Obama in 2008, the country moves left. But when voters try to change course, as we did in the elections of 2010 and 2014, the country still careened towards open borders, government control of healthcare, rule by rogue judges, and lawless license for those in the power elite.

And so we went outside the traditional path and elected Donald Trump in 2016. The liberal news anchors had barely dried their tears after Election Day when the left began to cloud the real meaning of Trump’s election by pushing the bizarre claim that the Russians had somehow hacked the election.

In their gaslighting version of reality, you didn’t really vote to drain the swamp. You didn’t really vote to secure our borders. You didn’t vote to repeal and replace Obamacare and put doctors and patients back in charge instead of Washington bureaucrats. You didn’t vote to restore rule of law and common sense to Washington. The Russians somehow threw the election to Trump. You can go back home now and let the experts run things.

It’s swamp gas. Don’t breathe it.

There is plenty in Washington that merits investigation, from foreign influence through the Clinton Foundation to Obama’s use of intelligence data for political purposes. Congress has the power to do just that, but we need to give them the will.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/05/trump-is-not-the-real-target-you-are.htmlWhat Are The Republicans in the Senate Doing?tag:typepad.com,2003:post-6a00d83451876469e201bb099ec7fb970d2017-05-24T17:35:27-05:002017-05-24T17:35:27-05:00Stanley Feld M.D.,FACP,MACE I am rapidly coming to the conclusion that the Republican establishment in both houses of congress are trying to torpedo Donald Trump’s agenda. Republicans had seven years to coordinate a bill to repeal and replace Obamacare. The...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

I am rapidly coming to the conclusion that the Republican establishment in both houses of congress are trying to torpedo Donald Trump’s agenda.

Republicans had seven years to coordinate a bill to repeal and replace Obamacare.

The House of Representative’s bill has finally past. Senate committees are stalling progress of the bill.

Both houses should have had all the debates and consensus reached to during the last seven years.

Why would congressmen try to stall the passage of the bill? President Trump has stated that passage of the budget bill is dependent on passage of the healthcare bill.

The reason is obvious to me.

President Trump has pledge to those who voted for him that he is going to drain the swamp in Washington. He is going to eliminate corruption and streamline the bloated bureaucracy.

The Republican establishment is a big part of the swamp. They are thriving in the swamp they helped create.

President Trump represents a direct threat to their power. The Republican establishment does not realize that the only reason they have a majority in both houses is because of the rebellion within the party against the Republican establishment.

Tea partyers and independents voted for unknown candidates and defeated many establishment Republicans in the primaries.

The goal of the Republican establishment is to weaken President Trump’s agenda.

They don’t understand that they are destroying the Republican Party while they are trying to save their own swamp.

It is time the Republicans in the Senate passed the bill.

Regulations that should be eliminated are any regulations that increase bureaucratic control over the healthcare system and the practice of medicine.

The healthcare community knows how to control the costs of chronic diseases. It is by decreasing the onset of complications. Patients have to participate in controlling their chronic disease.

If a healthcare system was developed to control the costs of these chronic diseases, the United States would not only have the best healthcare system in the world we would have the most cost effective healthcare system in the world.

The key to diabetes control and the avoidance of diabetes complications is to control blood sugar to a close to normal as possible. This takes a lot of work on the patient’s part. Patients need the education and the motivation to become the professor of their disease and control their blood sugar.

It is bizarre. Yet, Republican Senators who should have figured this out over the last seven years are debating small points that will have little effect on the clinical outcomes. The Republican Party has an opportunity of a lifetime to fix the healthcare system for the American people.

Republicans are going to waste this opportunity to serve the people in order to preserve their swamp that has gotten the people into this horrible position.

I am afraid we are going to see this behavior of perpetuating waste when it comes to education, the environment and energy.

The Democratic Party is worse. They are not acting in the peoples’ interest. They are trying to obstruct everything President Trump is trying to accomplish.

They criticize every initiative saying it is bad without providing reasons for why it is bad.

I believe it is time for the members of both parties to get off the stick. They must stop thinking about themselves and start thinking about the welfare of Americans.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/05/what-are-the-republicans-in-the-senate-doing.htmlDemocrats Still Think Americans Are Stupidtag:typepad.com,2003:post-6a00d83451876469e201bb099a19f2970d2017-05-10T22:53:39-05:002017-05-10T22:53:39-05:00Stanley Feld M.D.,FACP, MACE The House Republicans finally got their act together and passed their version of the Obamacare repeal and replace act. It seems that many representatives do not trust Paul Ryan, Tom Price and President Donald Trump. The...stanleyfeldmdmace

Stanley Feld M.D.,FACP, MACE

The House Republicans finally got their act together and passed their version of the Obamacare repeal and replace act. It seems that many representatives do not trust Paul Ryan, Tom Price and President Donald Trump.

The Republican house version of the bill does not repeal and replace Obamacare completely.

The Affordable Care Act (Obamacare) permitted Kathleen Sibelius, the Secretary of HHS, to issue regulations to administer the act at her discretion. Many of her regulations were destructive to the healthcare system.

Tom Price, the new Secretary of HSS can eliminate many of these destructive regulations. The goal of the Obama administration’s regulations was to cause the healthcare system to fail and be replaced not by free market principals but by a single party payer system.

Her regulations were designed to eliminate any modicum of free choice for patients and physicians.

Tom Price’s actions and regulation eliminations should complete the repeal and replacement of Obamacare.

President Obama ignored the fact that a single party payer system would be destined to bankrupt the country. His plan was to get the health care insurance industry out of the healthcare picture.

The defect in his logic was that the government would have to continue to outsource the administrative services to the healthcare insurance industry. The government now outsources the administrative services for Medicare and Medicaid.

The government then lies to the public declaring that its overhead is only 2.5% while the healthcare insurance industry takes 30% for services that are charged as direct patient care.

The healthcare insurance industry would continue to rip off the healthcare system in a single party payer system for all.

The completion of the repeal and replace act will be done as promised by Ryan, Price and Trump in three stages.

As soon as the house bill is passed the House Democrats came out with their talking points criticizing the act. These talking points had little substance and no compelling evidence. They only declared that the legislation was terrible without any explanation of why it was terrible.

They just said 20 million people are going to lose their insurance coverage. The Republican health care act is going to kill people.

The talking points are mostly lies.

A recent study had reported that Obamacare has cost 80,000 people to die.

"Democrat’s immediately made the accusation that the GOP "repeal and replace" bill will kill Americans. It seems that Obamacare has already done that.”

In a previous blog I pointed out that more people have lost insurance in the individual market that have gained insurance from Obamacare’s health insurance exchanges.

Fourteen million lost insurance in the individual market in 2009 and at most 8 million gained insurance through Obamacare’s health insurance exchanges.

The 20 million new insured comes from the 12 million new people receiving healthcare insurance through Medicaid.

“Quoting Oren Cass over at National Review, it turns out that fewer people – not more people – had health insurance after Obamacare. The only increase in "coverage" was Medicaid, but, sadly, it turns out that Medicaid kills people. It's better to have no medical insurance at all.”

Researchers have found that in 2015 Medicaid patients experienced worse outcomes than similar uninsured Medicaid eligible patients.

The Democrats are using the typical progressive tactic of creating a lie. Many people died because of Obamacare but the Democrats threaten that the Republican bill will cost many lives. It diverts attention from the Democrats’ failure with Obamacare.

This is fear mongering for the progressives’ political gain.

This is one of Sol Alinsky’s favorite tactics. One should do everything to marginalize opponents even if it needs to be done by lying.

“Democrats are hurting real people with their scary shrieking about death by Republican.”

The Democrats criticize without facts. The Democrats will lie about the effects of the bill without evidence. I would guess that many have not even read it.

One should expect nothing less from Nancy Pelosi and Chuck Schumer.

The Democrats have even rolled out Jonathan Gruber, the MIT professor of economics and co-author of Obamacare, who infamously said, “the stupidity of the American voter” helped get the measure to become law.

“To avoid following the lead of their colleagues in the House and to work on a bipartisan basis on healthcare reform rather than pushing for repeal of the Affordable Care Act.”

He is trying to save President Obama’s legacy Obamacare. Obamacare is an unmitigated disaster. It is beyond saving.

It was a poorly constructed healthcare bill aimed at giving big government total control of the healthcare system. President Obama totally ignores the fact that Americans did not want it, have not joined it. He felt he clearly know what is best for America.

He goal was to get it passed by the partisan vote. President Obama lied to Americans and lied to his party members.

Obamacare is unsustainable economically to America and is in the process of destroying the economy.

Chuck Schumer said, "Trumpcare is a giant, brokenpromise to working people, the hard-working people of this great country of ours."

It would be valid if Chuck Schumer could prove his statement.

President Obama broke his promise to the working people, the hard working people of this great country of ours, when he said, “ If you like your doctor you can keep your doctor and if you like your insurance you can keep your insurance.”

Chuck Schumer did not see it then and he does not see Obamacare’s failure now.

I suggest that Chuck Schumer read the Republican bill carefully before he makes his false statements.

Clearly, he was dead wrong in his judgment about Obamacare

If he read the Obamacare law carefully and voted for doing the right thing, America’s healthcare system might not be in the mess it is in.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/05/democrats-still-think-americans-are-stupid.htmlI Don’t Get The Republican Leadershiptag:typepad.com,2003:post-6a00d83451876469e201bb09955745970d2017-04-27T15:34:54-05:002017-04-27T15:34:54-05:00Stanley Feld M.D., FACP, MACE The media and Democrats in congress are stonewalling every initiative President Trump has presented whether or not it has merit. . The American people have spoken. Donald Trump is President. Republicans control both the House...stanleyfeldmdmace

Stanley Feld M.D., FACP, MACE

The media and Democrats in congress are stonewalling every initiative President Trump has presented whether or not it has merit. .

The American people have spoken. Donald Trump is President. Republicans control both the House of Representatives and the Senate.

I should think the Democratic leadership would realize they are not connecting with the people. They should fear for their jobs and the jobs of other party members.

Nancy Pelosi, chair of the House Democrats, said, “We are the opposition party and it is our job to be the opposition.”

She is wrong. The Democrat should be doing what is right for the American people.

Recent elections have proven Americans do not approve of the Democrats’ policies at federal, state or local levels.

President Obama’s Democratic court appointed judges are slapping temporary injunctions on some of President Trump’s executive orders for no logical reasons.

These injunctions are occurring despite the terrorist disruptions that have occurred in American cities.

President Obama and the Democrats did nothing to neither stop this loss of life nor decrease the fear these terrorists generated.

The judges are slowing his initiatives down until they get to higher courts.

Democrats are acting juvenile.

Paul Ryan and the Republican establishment are not helping President Trump fulfill his agenda. They seem to be tripping up President Trump at every turn.

At the same time they are making the Republicans look bad and the Democrats look good.

If some of President Trump’s executive orders need congressional approval the Republican leadership in both houses should start the legislative process to get that congressional approval.

It seems like the Republican establishment is doing everything to make President Trump an ineffectual president.

The Republican establishment is bickering over the fine points of the initiatives. They are not looking at the big picture.

The American public gave the Republicans both houses of congress in order to allow them to be effective. The nuclear option in the senate should guarantee legislative effectiveness.

President Trump has some good ideas to fix the healthcare system and create economic growth.

Paul Ryan is supposed to be a legislative genius.

Paul Ryan seems to be intimidated by the Democrats and the mainstream media. He has not been bold in stepping out and supporting President Trump’s initiatives.

He should realize that the majority of the American public is not paying attention to the mainstream media.

This is reflected in the decrease in readership of the New York Times and the viewership at CNN and MSNBC. The mainstream media should not be influencing Paul Ryan’s actions.

Everything President Obama did during his presidency slowed the economy and polarized the nation. Paul Ryan should be doing the opposite.

Everything President Obama did with Obamacare made the healthcare system less efficient and more dysfunctional. Paul Ryan should have had a Republican consensus plan ready to repeal and replace Obamacare.

It is embarrassing that he did not have a plan ready after seven years.

My advice to the Republican controlled congress is to give President Trump a break and give him some support.

Stop playing politics. You are playing right into the Democrats’ obstructionist hands.

Paul Ryan’s healthcare fiasco is the prime example. He wouldn’t be speaker if it would not for the election of members of the Freedom Caucus.

Paul Ryan should take the bill the house previously passed and send it to the Senate. If there are things in that bill that do not pass the sequestration test for the Senate to pass the bill with 51 votes modify the bill.

Ryan has not made it clear to the public what he thinks is wrong with the old bill. He has also been secretive about the ongoing negotiations to repeal and replace Obamacare.

Now Paul Ryan is delaying President Trump’s wall appropriation request. He seems to be delaying President Trump’s tax cut initiative until 2018 without explanation.

If it is because the healthcare bill is not passed then pass the old healthcare bill.

He and the establishment Republicans confuse me. I think the American people are confused. Maybe the Republican establishment has to be voted out of congress in order to get anything passed.

I believe what President Trump is trying to accomplish is pretty logical. President Obama and the Democrats messed us up over the last eight years.

Many Americans are hurting. Americans who are not hurting do not understand it. Perhaps they refuse to understand it.

It is time government starting working and trying new ideas.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

Ms. Rosenthal’s story is about how this poor woman, Wanda Wickizer, got trapped in the dysfunction of the healthcare system’s coding system.

Wanda Wickizer should have been insured through Obamacare. However, through the inefficiencies of the government or Ms. Wickizer lack of understanding of Obamacare she did not have insurance.

The healthcare system makes no provisions for billing the uninsured.

There are multiple prices charged for treatments and procedures. Hospital systems and physician groups have their own individual retail prices for services and procedures.

These providers negotiate prices with the government and the healthcare insurance industry.

There are many different prices negotiated by many different providers with the healthcare insurance industry. A healthcare insurance company negotiates many of the government’s final prices. The healthcare insurance company acts as the surrogate for the government.

None of these prices are transparent.

There is no one that negotiates price for the uninsured. The uninsured are responsible for the retail price of the services rendered unless they can negotiate a better price.

$16,000 from Sentara Norfolk (not including the scan or the E.R. doctor), $50,000 for the air ambulance.

Her local hospital

By the end of January, there was also one for $24,000 from the University of Virginia Physicians’ Group: charges for some of the doctors at the medical center. “I thought, O.K., that’s not so bad,” Wickizer recalls.

A month later, a bill for $54,000 arrived from the same physicians’ group, which included further charges and late fees.

Then a separate bill came just for the hospital’s charges, containing a demand for $356,884.42 but little in the way of comprehensible explanation.”

The uninsured are the only people who are responsible for the original retail prices. All the rest of the payment providers, namely the government and various members of the healthcare insurance industry pay their negotiated fees.

Shouldn’t the government pass a law requiring hospitals and doctors to charge only Medicare prices to the uninsured? It would eliminate Ms. Wickizer bill, a bill that reflects retail prices for services rendered.

The big mistake the University of Virginia made was that it did not provide her with a line item bill identifying the price of each service and procedure.

The University of Virginia subsequently refused to provide a line item bill to the patient. It was as if the university was hiding something.

Any thoughtful hospital administrator would have solved the problem in a minute.

It must be remembered that each provider has a different retail price per procedure and service. The reasoning is that they are trying to collect the highest amount they can.

The patient could then figure out what Medicare pays for those services and procedures.

However none of these line item charges are in the patients (EOB) Explanation Of Benefits. The EOB is impossible to interpret.

A simple rule should be passed by congress or issued by CMS saying a clear explanation of charges is required for payment of the bill.

The Obama administration knew about this uninsured billing problem. It did nothing about it because it wanted to force patients into buying Obamacare insurance even if they couldn’t afford it or didn’t need it.

I believe Tom Price M.D. (President Trump’s head of CMS) is aware of the problem. He also understands this simple way of solving it.

The healthcare insurance industry and the government get a detailed EOB for services rendered through the CPT coding system first established in 1978.

The Obama administration added 74,000 new codes to the CPT coding system. The government and the insurance companies wanted to know what they were paying for in detail.

This led to the requirement for Electronic Medical Records (EMR) and then meaningful use EMRs. Physicians and hospital systems will not get paid if they do not have a meaningful use EMR this year.

This led to a very expensive EMR development industry. EMRs were expensive. They did not function as meaningful use EMRs. They had to undergo extensive upgrades.

An EMR function should really be a teaching tool, teaching physicians how to upgrade their services to the best evidence based medicine practices.

Instead it has become a tool for the government and the healthcare insurance industry to punish patients.

The EMRs are unaffordable to many physicians. It has force them to sign up to become hospital system employees.

The government should have built a universal EMR in the cloud and charged physicians by the click.

The increase in codes led to an expensive coding industry. People are trained to teach physicians and hospital systems how to use the new 88,00 codes correctly.

The industry essentially teaches those providers how to how to game the healthcare system so that they can collect the most money for their services from the government and the healthcare insurance industry.

The goal of the government is to reduce reimbursement to providers.

Where is the consideration for patients in all of these maneuvers?

Where is the consideration for the uninsured patients?

Ms. Rosenthal’s main point is that CPT gaming by the medical professions and hospital systems are driving up healthcare costs.

However, missing from her argument is who developed the dysfunction CPT system.

Why was it developed?

Why was coding made so complex that it drives users of the coding system to game the system?

Ms. Rosenthal’s story is about how this poor woman, Wanda Wickizer, got trapped in the dysfunction of the healthcare system’s coding system.

Wanda Wickizer should have been insured through Obamacare. However, through the inefficiencies of the government or Ms. Wickizer lack of understanding of Obamacare she did not have insurance.

The healthcare system makes no provisions for billing the uninsured.

There are multiple prices charged for treatments and procedures. Hospital systems and physician groups have their own individual retail prices for services and procedures.

These providers negotiate prices with the government and the healthcare insurance industry.

There are many different prices negotiated by many different providers with the healthcare insurance industry. A healthcare insurance company negotiates many of the government’s final prices. The healthcare insurance company acts as the surrogate for the government.

None of these prices are transparent.

There is no one that negotiates price for the uninsured. The uninsured are responsible for the retail price of the services rendered unless they can negotiate a better price.

$16,000 from Sentara Norfolk (not including the scan or the E.R. doctor), $50,000 for the air ambulance.

Her local hospital

By the end of January, there was also one for $24,000 from the University of Virginia Physicians’ Group: charges for some of the doctors at the medical center. “I thought, O.K., that’s not so bad,” Wickizer recalls.

A month later, a bill for $54,000 arrived from the same physicians’ group, which included further charges and late fees.

Then a separate bill came just for the hospital’s charges, containing a demand for $356,884.42 but little in the way of comprehensible explanation.”

The uninsured are the only people who are responsible for the original retail prices. All the rest of the payment providers, namely the government and various members of the healthcare insurance industry pay their negotiated fees.

Shouldn’t the government pass a law requiring hospitals and doctors to charge only Medicare prices to the uninsured? It would eliminate Ms. Wickizer bill, a bill that reflects retail prices for services rendered.

The big mistake the University of Virginia made was that it did not provide her with a line item bill identifying the price of each service and procedure.

The University of Virginia subsequently refused to provide a line item bill to the patient. It was as if the university was hiding something.

Any thoughtful hospital administrator would have solved the problem in a minute.

It must be remembered that each provider has a different retail price per procedure and service. The reasoning is that they are trying to collect the highest amount they can.

The patient could then figure out what Medicare pays for those services and procedures.

However none of these line item charges are in the patients (EOB) Explanation Of Benefits. The EOB is impossible to interpret.

A simple rule should be passed by congress or issued by CMS saying a clear explanation of charges is required for payment of the bill.

The Obama administration knew about this uninsured billing problem. It did nothing about it because it wanted to force patients into buying Obamacare insurance even if they couldn’t afford it or didn’t need it.

I believe Tom Price M.D. (President Trump’s head of CMS) is aware of the problem. He also understands this simple way of solving it.

The healthcare insurance industry and the government get a detailed EOB for services rendered through the CPT coding system first established in 1978.

The Obama administration added 74,000 new codes to the CPT coding system. The government and the insurance companies wanted to know what they were paying for in detail.

This led to the requirement for Electronic Medical Records (EMR) and then meaningful use EMRs. Physicians and hospital systems will not get paid if they do not have a meaningful use EMR this year.

This led to a very expensive EMR development industry. EMRs were expensive. They did not function as meaningful use EMRs. They had to undergo extensive upgrades.

An EMR function should really be a teaching tool, teaching physicians how to upgrade their services to the best evidence based medicine practices.

Instead it has become a tool for the government and the healthcare insurance industry to punish patients.

The EMRs are unaffordable to many physicians. It has force them to sign up to become hospital system employees.

The government should have built a universal EMR in the cloud and charged physicians by the click.

The increase in codes led to an expensive coding industry. People are trained to teach physicians and hospital systems how to use the new 88,00 codes correctly.

The industry essentially teaches those providers how to how to game the healthcare system so that they can collect the most money for their services from the government and the healthcare insurance industry.

The goal of the government is to reduce reimbursement to providers.

Where is the consideration for patients in all of these maneuvers?

Where is the consideration for the uninsured patients?

Ms. Rosenthal’s main point is that CPT gaming by the medical professions and hospital systems are driving up healthcare costs.

However, missing from her argument is who developed the dysfunction CPT system.

Why was it developed?

Why was coding made so complex that it drives users of the coding system to game the system?

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/04/those-indecipherable-medical-bills-part-2-cpt-coding-is-one-reason-health-care-costs-so-much.htmlThose Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much: Part 1tag:typepad.com,2003:post-6a00d83451876469e201b7c8ef56a9970b2017-04-19T16:34:44-05:002017-04-19T16:34:44-05:00Stanley Feld M.D.,FACP,MACE Elisabeth Rosenthal is editor in chief of Kaiser Health News and a former senior writer at The New York Times. She wrote an extensive article in the New York Times Sunday Magazine Section on the abuse of...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

Elisabeth Rosenthal is editor in chief of Kaiser Health News and a former senior writer at The New York Times.

Ms. Rosenthal usually points out defects in the healthcare system in great detail. She usually ignores the primary causes of those defects which leads to stakeholders’ adjustments.

Those adjustments lead to abuses of both the healthcare system and consumers utilizing the healthcare system.

It is important for all consumers and politicians (designated surrogates of consumers) to understand these abuses in detail.

It is doubly important that consumers and politicians understand the primary causes for these abuses.

The ideal goal would be to fix the primary causes so that stakeholders cannot abuse the system. In Ms. Rosenthal’s case study the University of Virginia’s bureaucrats are the decision makers who are far removed from the primarily medical care of patients.

They are far removed from the development of a physician/patient relationship. The patient/physician relationship is so vital to the success of a healthcare system.

These bureaucrats are immune to the tragedy that had befallen Ms. Rosenthal’s example, Ms. Wanda Wickizer. They are stuck in the rules its organization made or their interpretation of these rules.

There does not seem to be any flexibility built into the University of Virginia’s Medical School billing system.

The patient in Ms. Rosenthal story is not entirely immune to the disaster that occurred subsequently.

Her husband died in 2006. He had great city of Norfolk Virginia health insurance. The city of Norfolk continued providing her and her kids with insurance for the next three years.

“After his death, Wanda Wickizer worked in a series of low-wage jobs, but none provided health insurance. A minor pre-existing condition — she was taking Lexapro, a common medicine for depression — meant that her only insurance option was to obtain Obamacare insurance through a health insurance exchange in 2010.

In 2009 only ineffective and costly state administered “high-risk pools” were available. High risk pools disappeared in 2010 with the passage of Obamacare.

She said she could not afford her Obamacare option. However, she did not consider the Obamacare option in her economic condition. Obamacare would have subsidized her insurance coverage up to 100%.

“She thought she would need to pay more than $800 per month for a policy with a $5,000 deductible, and her medical procedures would then be reimbursed at 80 percent. She felt she couldn’t afford that.”

She made a decision that did not take into account a potential medical catastrophe.

“In 2011, she decided to temporarily stop working to tend to her children, which qualified them for Medicaid; with trepidation, she left herself uninsured.”

At this point she probably would, also, have qualified for Medicaid or gotten insurance through the health insurance exchanges that would have been subsidized up to 100% by Obamacare.

Additionally, after she was sick she could have applied for Obamacare insurance. She would have supposedly received full insurance coverage at no cost to her. The application for Obamacare after the onset of an illness is one of the major objections to Obamacare.

This is a defect in Ms. Rosenthal’s story. It could have easily been avoided if Ms. Wickizer applied for insurance available to her at minimal charge.

The casual reader of the Sunday NYT magazine section could easily overlook this defect.

The rest of the story is about the billing catastrophe. Ms. Rosenthal exposes all the defects in the healthcare billing system structure.

A catastrophic illness struck Wanda Wickizer on Christmas Day 2013. It was a subarachnoid hemorrhage that can strike at any time.

“The catastrophe struck Wanda Wickizer on Christmas Day 2013.”

It occurred four years after Obamacare was enacted. She had a debilitating headache. The ambulance paramedics missed the diagnosis. They thought she had food poisoning and did not take her to the hospital.

Later, she, at 3 a.m. became confused and groggy. Her boyfriend raced her to Sentara Norfolk General Hospital. A CAT scan revealed a subarachnoid hemorrhage.

Sentara Norfolk General Hospital felt it could not handle the subarachnoid hemorrhage and air evacuated her by helicopter to University of Virginia Medical Center in Charlottesville 160 miles away.

At UVM the hemorrhage was stopped and the previous accumulation of blood evacuated. She was in the hospital for 3 weeks. When she was home the catastrophe of the healthcare system coding process began.

Ms. Wanda Wickzer’s story will be continued in Part 2 of Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/04/those-indecipherable-medical-bills-cpt-coding-is-one-reason-health-care-costs-so-much-part-1.htmlFeld Men’s Weekendtag:typepad.com,2003:post-6a00d83451876469e201b7c8ebcd0b970b2017-04-10T08:59:44-05:002017-04-10T08:59:44-05:00Stanley Feld M.D.,FACP,MACE Every year I have gone away with each of my sons, Brad and Daniel for a weekend. We just talk about our lives and have a good time being with each other. I figure it is good...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

Every year I have gone away with each of my sons, Brad and Daniel for a weekend. We just talk about our lives and have a good time being with each other.

I figure it is good for our health. The boys agree.

My readers have had an extremely positive response to past where I have written about these one on one trips.

Readers know my bother and I are very close. He also lives in Dallas. We meet and have a pastrami sandwich together once a month whether we need it or not.

We have also gone away for weekends in the past with all the Feld men, my two sons and my brother’s two sons.

These weekends have been great for all of us. My sons live in Boulder Colorado, Kenny lives in Atlanta and Jon lives in Dallas.

The boys were close as kids. They have not gotten together very much in the last few years.

However, they love the weekends we have had to bond and just have fun.

It has been very difficult to get everyone together the past four years. This year Brad was determined to make it work. He got tickets to the NCAA finals.

The notification said anyone who can come should come. Unfortunately, Daniel could not come. He and his family were going to be in Japan that week.

The Feld Men have officially added a new member to the group. Jon's son Jack is now 16.

Jack is a very smart kid. He kept up with all of our conversations. He even taught us a bunch of things.

I welcome Jack to the club!

My brother and I took 7.30 am Southwest Airlines flight to Phoenix on Friday March 31.

Kenny, Jon and Jack were not coming in until Saturday at 10.am. Brad was in Scottsdale for the previous month.

Charlie and I decided we wanted to hang out with Steve Hochschuler and his wife Kim all day Friday.

Steve is co-founder of Texas Back Institute. He has been a good friend since 1970. We both graduated from Columbia College.

Steve now lives in Desert Mountain part-time. He and Kim showed us a great time. Desert Mountain is very upscale. There are lots of big houses, and fancy cars.

There are very few trucks in his neighborhood. Steve has been irreverent all of his life. Steve has the biggest truck with the biggest and bad-est tires I have ever seen.

Their house is magnificent. Lunch and diner at local Desert Mountain restaurants were wonderful.

Steve and Kim took us to a neighbor’s house for a wine tasting with food before dinner. Both the wine and the food were out of sight.

They are living the good life.

This was a good start for the weekend. Charlie and I then drove to the Sanctuary in Paradise Valley to meet up with Brad.

The house Brad rented was beautiful. It had a pool and a tennis court with magnificent mountain views.

I was so tired I fell asleep instantly.

On Saturday morning Jon, Kenny and Jack all arrived at 10 am. We went out for breakfast/brunch to a place Brad and Amy found called Scramble.

Scramble looks like a PF Changs with menus on the sidewall as you wait on line to order and choose your food. The have everything from the simple breakfast to the most exotic omelets, waffles and pancakes.

We ate enough breakfast for a week but we were not finished.

Our next stop was Dairy Queen. This old Dairy Queen was a standout in a contemporary designed Scottsdale shopping center.

Neither Jon, Kenny nor Jack ever had a Dairy Queen Blizzard.

Brad and I told them they had to have a Chocolate Extreme Blizzard.

All three were hesitant by finally complied.

They all loved it.

DQ icream thick enough not to spill.

Next back to the Sanctuary and Brad’s house. It was time to hang out with each other.

After a while we all took our Feld traditional afternoon nap.

I learned to nap in a chair as a medical intern in 1963.

The “car” picked us up at 2:15 for a 5:09 starting time for Gonzaga vs. South Carolina. The games were being played at the Arizona Cardinals football field in Glendale Arizona.

It was far from Scottsdale and the traffic on Saturday afternoon was horrible.

Brad had Jon pick the seats because Jon was experienced in watching basketball in a football stadium.

He picked great seats on the 50 yard line in row D of the first deck. The people watching on the floor had to strain their necks. They were always looking up. The playing field was raised a couple of feet.

The North Carolina vs. Oregon game followed. It thought both games stunk. All four teams had terrible shooting percentages.

The television timeouts were endless. They took up more time than the regular timeouts. It became annoying.

The food was the typical terrible stadium food. Some stadiums and arenas I have been to have pretty good food including Coors Field, Fenway Park, the Yankee Stadium and the American Airlines Arena in Dallas.

After the games we found our driver easily. He was a master of heavy traffic driving and got us home nicely.

All of us were bushed except for Jack. He was hungry. He wanted a hamburger at 10:30 pm. I guess this is what happens when you are a sixteen year old.

On Sunday morning we all met at 9:30 a.m. for a 9:45 a.m. reservation at Rita’s Kitchen at the suggestion of Kim Hochschuler.

She took Cecelia and me to Rita’s once before. The atmosphere was as good as ever. It was a two and a half hour brunch.

After brunch some quiet time at the Sanctuary. At about 2:30 I went to the fitness center to work out and then to the pool.

We had a six o’clock reservation at the Wildfish Sea Food Grille in Scottsdale. Jack picked up the fact that the font on the menu and the description of the dishes were the same as Eddie V’s in Dallas.

Everyone wiped out their cell phones to see if there was a relationship. There is. The Darden Restaurant chain owns both restaurants as well as Olive Garden, Red Lobster, Seasons 52 and the Capital Grille.

Three of us had steak and three had fish. The waiter was upset that the chef undercooked the steaks. He complimented desert for the table.

I was afraid we were all going to miss the hot fudge sundaes at the Sugar Bowl in Downtown Scottsdale.

The desert was fair. They did not have chocolate ice cream in the restaurant.

After diner we went back to Brad’s rental house. We all watched 1941. I thought it was the dumbest movie I ever saw.

It was a 1979 flick for teenage boys. My bother and Kenny baled after 20 minutes. I stay to the end. Brad and Jon were teenagers in 1979. They thought it was great then but lousy now.

Monday was the day of the finals between Gonzaga and North Carolina.

We had lunch at a Sports Bar. Then we finally got to the Sugar Bowl to have their fabulous hot fudge sundae.

Brad and me eating at Sugar Bowl

We left for the NCAA Final at 2:30 to beat the traffic for a 6:09 p.m. game.

I will not complain about the traffic in Dallas, Texas anymore. We got to the stadium at 5:30 p.m.

Both teams played a lousy game. Shooting percentage for both was under 40%. Free throw percentage was not much better.

However, the festival of the NCAA final and the excitement of the crowd made the lousy game worth it.

When we arrived at Brad’s house Jack needed a hamburger at 10:30 p.m. again.

I went to sleep immediately because we were leaving for the airport at 5.15 a.m.

I slept on the plane for the entire ride home.

This was another successful “Feld Men’s Trip.” I can’t wait until next year.

The opinions expressed in the blog “Repairing The Healthcare System” are mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/04/feld-mens-weekend.htmlLet The Buyer Beware: Medicare Part Dtag:typepad.com,2003:post-6a00d83451876469e201b7c8e6f0d4970b2017-03-30T15:52:26-05:002017-03-30T15:52:26-05:00Stanley Feld M.D.,FACP,MACE The mystery of buying drugs under Medicare Part D increases each year. The plans offered become more costly and complicated. https://en.wikipedia.org/wiki/Medicare_Part_D Medicare did not cover outpatient prescription drugs until January 1, 2006, when it implemented the Medicare...stanleyfeldmdmace

Medicare did not cover outpatient prescription drugs until January 1, 2006, when it implemented the Medicare Part D prescription drug benefit.

Congress authorized Medicare Part D with the heading the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003."

Private insurance companies administer Medicare Part D plans for the government. The government is not allowed to negotiate drug prices with the pharmaceutical companies.

The VA healthcare system negotiates prices with the pharmaceutical companies. The prices are at least 60% lower than the Part D prices.

Multiple plans are offered with increasing premium prices and deductibles each year.

The increases in deductibles are significant. Below are the increases between 2016 and 2017. Most seniors do not pay attention to the increase in premiums, deductibles or coverage because they automatically enroll each year.

They become aware of the changes changes when they go to pay for their medication

 Initial Coverage Limit: will increase from $3,310 in 2016 to $3,700 in 2017.

 Out-of-Pocket Threshold: will increase from $4,850 in 2016 to $4,950 in 2017.

 Coverage Gap (donut hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($3,700 in 2017) and ends when you spend a total of $4,950 in 2017.

In 2017, Part D enrollees will receive a 60% discount on the total retail cost of their brand-name drugs purchased while in the donut hole.

Generally, not all drugs are covered at the same out of pocket cost to the beneficiary. This gives participants incentives to choose certain drugs over others. This is most often implemented—as is the case for drug coverage for those not on Medicare—through incentives to use generic drugs over brand-name drugs.

The incentive is also often implemented via a system of tiered formularies in which some brand-name drugs are less expensive than others and not subject to step therapy.

Generic drugs are less expensive than brand named drugs. Patients learned this quickly. They encouraged their physicians to provide them with a prescription for generic drugs.

When patients buy drugs with Medicare Part D the deductible price is the patients’ cash outlay. However, the Medicare Part D plan charges patients the total retail price of the drug against their donut.

For example if a 90 day supply of a generic drug is $10 and the retail price is $60 dollars, the $60 is charged against the patient’s donut to be added to future purchases.

If patients paid $10 cash already shouldn’t only $50 of the $60 be charged against the donut?

Many generics can be purchased for a cash price or using a discount drug card coupon for $10 without using Medicare Part D and incurring the $60 retail charge against a donut.

Many generics can be purchased for less using a discount drug card coupon than the cash price a senior on Medicare Part D has to pay using Medicare Part D insurance.

It is not uncommon for senior patients to reach their donut in less than a year. At that time those senior patients have to pay 100% (60% in 2017) of the retail price for a drug until they reach $4,950.

The amount is an additional cash price of $1,250.

It was difficult to figure this out before discount drug cards became available.

How do these discount drugs card work and the discount drug card companies make money?

None of these government policy manipulations are to senior recipients of Medicare Part D advantage. They all benefit the middlemen.

A simple solution is to change the Medicare Part D law so the government can negotiate the cost of drugs just as all the middlemen in the Discounted Drug Card industry are negotiating the price of drugs to the advantage of seniors.

Sometimes the discount cards yield different discounts in different pharmacies in the same zip code.

Sometimes the pharmaceutical companies figure out how to combine two medications that are just as effective when taken separately to increase the cash price to senior patients.

These companies do it with FDA approval.

I became aware of the vast price differences recently with two commonly used drugs Dutasterile (Brand name Avodart) and Tamusulosin (Flow Max). Both drugs have been on the market long enough to be sold as generic drugs.

Using the Good RX discount card these are the variation in prices for the combination drug and the drugs sold separately in one zip code.

Dutasterilde +

Tamsulosin 90

Dutasterile 90

Tamusulosin 90

Walgreens

$183.00

$183.08

$113.93

Kroger

$316.98

$45.61

$30.62

CVS

$388.69

$84.63

$58.62

Tom Thumb

$391.85

49.85

$31.85

Albertson

$391.60

$52.60

$31.85

Walmart

$475.10

$398.71

$55.23

Target

$388.69

$388.71

$136.41

Table 1

None of the pharmacies receive an appropriate discount for the combination of Dutasterile plus Tamulosin. Only Kroger’s negotiator received an appropriate discount for the two drugs sold separately. The total price is $76.23 for 90 pills vs. $316.98 for the combination.

However, seniors have run into a problem in shopping for the best price in a neighborhood.

The government provides a bonus to physician practices that have meaningful use electronic medical records.

One criterion for a meaningful use electronic medical record is the electronically ordering prescriptions for patients.

If a patient usually used the Wal-Mart Pharmacy that telephone number would be in the record. The physician’s prescription would automatically be sent to the Wal-Mart Pharmacy. If the physician wrote for the combination for it would cost $475.10. If the physician wrote the prescription for each medication separately in would cost the patient $453.94 as opposed to cost him $76.23 at Kroger’s.

Compounding the complexity of the electric medical records unintended consequence the pharmacist would automatically fill the combination prescription using that senior’s Medicare Part D insurance. It would be much cheaper than the cash price.

The senior would pay only $146.50 for the combination but his donut would be charged the full retail price of $475.10.

The physician’s office should be aware of the difference in price between the generic combination and the generic drugs sold separately. However, that is not the physicians job.

He should be able to give the patient a paper prescription for both the combination and separate medication so the patient would be able to shop for the best price in his zip code if he was so inclined.

Clearly Medicare Part D is a mess and needs straightening out.

The discount drug cards are not the answer on top of the rising Medicare Part D premiums.

Many retired seniors are living month to month on a pension. The Medicare Part D premiums are paid with after tax dollars not pre-tax dollars.

Many seniors simply cannot afford to pay for their medication. If they do not take their medication they will develop complications of their disease.

Medicare Part A and B will cost the government more and become more unsustainable.

A few simple fixes can solve the problems in Medicare Part D that policy makers and congressmen do not seem to be aware of.

Patients must be responsible for their medical care and their healthcare dollars.

It would be nice if the government would help a little with fixes in information and policies that work for senior patients.

In the meantime it is imperative to “Let the Patient Beware.”

The opinions expressed in the blog “Repairing The Healthcare System” are mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/03/let-the-buyer-beware-medicare-part-d.htmlObamacare Coverage: The Big Lietag:typepad.com,2003:post-6a00d83451876469e201bb09876dec970d2017-03-25T15:14:34-05:002017-03-25T15:14:34-05:00Stanley Feld M.D., FACP, MACE President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success. The Obama administration told us that 20 million new people have obtained healthcare insurance...stanleyfeldmdmace

Stanley Feld M.D., FACP, MACE

President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success.

The Obama administration told us that 20 million new people have obtained healthcare insurance because of Obamacare.

We know 14.5 million people lost their healthcare insurance in the individual market the year after Obamacare was passed.

Many assumed they got their insurance back through Obamacare. There is no evidence for that assumption.

I followed Obamacare enrollment carefully on acasignup.net.

This site was supposed to be publishing the exact numbers published by the government weekly. www.acasignups.net

It turns out that the numbers published were inaccurate. They were too high.

This means only 2,240,000 people signed up in President Obama’s Health Insurance Exchanges.

It also means that there were 11,760,000 new Medicaid or S-Chip patients.

Edmund F. Haislmaier concluded in testimony to congress;

“While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that

for the three year period 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private sector coverage enrollment.”

Eighty-five percent of the 2.7 million have pre-existing conditions. Most are receiving government subsidies.

The 2.7 million covered under Obamacare have destabilized the healthcare insurance market so that healthcare costs for businesses have become unaffordable.

No one has even mentioned the cost of this Obamacare folly to the average hard working taxpayers with healthcare coverage from their employers.

Obamacare’s failure to has been devastating.

“The authors also found that nearly half the new Medicaid enrollees met eligibility standards that were in place before the ACA.”

Maybe Jonathan Gruber is right when he said we, the public, are too stupid to know the wool is being pulled over their eyes.

“For all the hoopla about the ACA exchanges, it appears that Medicaid accounts for the lion's share of coverage gains and that many new Medicaid enrollees would have been eligible for that program even if the ACA had never passed.”

Medicaid is a single party payer system (socialized medicine) that works very poorly. It is almost as bad as the VA Healthcare System.

Is this what the public wants? No

America needs a better healthcare system. Hopefully Dr. Tom Price knows what to do replace Obamacare with once he dismantles all of the Obama administrations regulation.

Maybe Jonathan Gruber is wrong.

The general taxpayer may be smarter than Dr. Gruber thinks. Maybe it is the reason the public elected Donald Trump.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/03/obamacare-coverage-the-big-lie.htmlStop The Noise: Start Workingtag:typepad.com,2003:post-6a00d83451876469e201b7c8e337f4970b2017-03-22T15:45:40-05:002017-03-22T15:45:40-05:00Stanley Feld M.D.,FACP, MACE The New York Times is filled with case reports of people helped by Obamacare. The implication is Obamacare is successful and the Republicans do not have a better plan. Articles appear daily defending Obamacare despite the...stanleyfeldmdmace

Stanley Feld M.D.,FACP, MACE

The New York Times is filled with case reports of people helped by Obamacare.

The implication is Obamacare is successful and the Republicans do not have a better plan.

Articles appear daily defending Obamacare despite the fact that premiums and deductibles are up, access to care and coverage is down and the medical profession and consumers are despondent.

Diseases such as multiple sclerosis, rheumatoid arthritis, infertility and others high cost conditions are being charged higher deductibles, experiencing more prior-authorization for drugs, an increase in lesser quality substitution drugs, and often no coverage for the drugs they need.

Most of these conditions require long- term expensive medications.

Therefore consumers with these diseases cannot get treated adequately.

For example, a patient with multiple sclerosis might file a $61,000 claim.

Insurers lose money on every MS patient. An incentive is created for insurers to avoid enrolling patients with MS. The insurers then make its healthcare policy unattractive to people with multiple sclerosis.

Obamacare’s subsidy for patients with multiple sclerosis is inadequate for the cost of the disease’s care.

The insurer doesn’t want to loss $14,000 per patient. Patients are not stupid. They find the best coverage at the lowest price,

This insurer suffers high losses. He either leaves the market or decreases coverage. The perverse incentive leads to low quality care.

Patient with multiple sclerosis on Obamacare are not getting high quality healthcare.

Everyone losses. The government loses, the insurer loses but most of all the patient loses.

There is a better way to insure these people. In a free market system driven by my ideal medical saving accounts the creation of a high risk pool funded by all participating insurance companies in the lucrative private market spreads the risk to insurance companies and government while providing high quality care to qualified patients.

Politicians must start thinking smart.

The format of previous high-risk healthcare insurance pools was a disaster for all the stakeholders. High-risk pools can be formatted in a way that works for patients and does not contaminate the private market with spiraling insurance prices.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/03/stop-the-noise-start-working.htmlI Was Wrongtag:typepad.com,2003:post-6a00d83451876469e201b8d26a7918970c2017-03-13T20:06:06-05:002017-03-13T20:06:06-05:00Stanley Feld M.D.,FACP,MACE I was profoundly disappointed when The American Healthcare Act was introduced last week. There was immediate rejection by Republicans and Democrats in both the House and Senate. The mainstream media commentators emphasized the Republicans’ rejections and added...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

I was profoundly disappointed when The American Healthcare Act was introduced last week. There was immediate rejection by Republicans and Democrats in both the House and Senate.

The mainstream media commentators emphasized the Republicans’ rejections and added their own scornful objections. The mainstream media painted the Republican Party as a party is disarray.

The media was presumably giving a boost to the Democratic Party and Obamacare’s failure.

Both Paul Ryan and Dr. Tom Price gave complete explanations of their strategies on how this bill, along with its two other components, will repeal and replace Obamacare.

I was profoundly disappointed in the bill until I was able to hear Dr. Tom Price and Paul Ryan’s explanation of their reasons for the initial reconciliation bill and the plan of the other two components necessary for replacement.

Vice President Pence and President Donald Trump then repeated Ryan ad Price’s strategy in less detail.

By that time there was so much mainstream media noise and politician noise that It was impossible to hear what Tom Price and Paul Ryan were trying to say.

No one listened to what President Trump was trying to say. They were only listening to the media describing Republican caucus’ members outburst against the bill.

President Trump tweeted “it is a beautiful healthcare bill. Everyone will be happy with the result.”

No one listened. No one heard.

The mistake Ryan and Price made was that in the initial introduction of the bill they were being too cute, cunning and clandestine. In reality they were very prepared. They have been working of this repeal and replacement since 2010.

The plan to repeal and replace Obamacare has three parts.

Reconciliation

Administrative Action

Additional Action

It would be very helpful to understand their positions if you watch them explain their positions in their entirety.

This lecture by Paul Ryan is an excellent review of the metodology necessary to Repeal and Replace Obamacare

Both videos are a must see in order to understand the Trump administration and congressional leadership strategy.

Obamacare was supposed to provide an opportunity for people in the individual insurance market to buy healthcare insurance at an affordable price. It was not meant to affect the employer provided healthcare insurance market.

This was supposed to be done by State Health Insurance Exchanges that would supply this insurance. Much of the individual market would be subsided by the federal government..

Only 22 states signed up and most have failed after receiving over $200 billion dollar loans to cover startup cost. These state health insurance exchanges are never going to pay back the federal loans.

Additionally, Obamacare extended Medicaid coverage by increasing the poverty levels in states. This increased the eligibility for patients to participate in Medicaid.

President Obama completely ignored the fact that Medicaid was a financially unsustainable subsidy that was failing rapidly.

Thirty-three States signed up for this expanded Medicaid coverage because they were afraid to get stuck with the bill.

All states are supposed to have balanced budgets. Most states have budget deficits.

They share the costs of Medicaid with the federal government to provide free healthcare coverage to the poor.

President Obama said he would pay 90% of the Medicaid bill. He then increased it to 95% and then 100% in the first few years in order to induce states to join.

Remember, President Obama’s ultimate goal was to have the federal government be in total control of healthcare with a single party payer system.

Twelve million new people have signed up for Medicaid under Obamacare. Additionally new immigrants have been added to the Medicaid roles.

Only nine million have signed up for Obamacare through the health insurance exchanges. Most of the enrollees have preexisting illness.

Most of the enrollees cannot afford the premiums even though President Obama provides subsides to 85% of these people.

Additionally, these enrollees cannot afford the deductibles that are up to $6,000 in some states.

Obamacare has affected the employer market. Obamacare does not pay the insurers enough or have a high enough enrollment distribution to give the insurance industry a high enough return on investment.

Insurers compensate by increasing insurance rates in the employer sponsored private market in almost all of the states. The industry increased rates in both individual and employer sponsored private market by as much as 116% in Arizona.

This forces small and large employers to decrease insurance coverage for employees.

If they did not provide healthcare insurance many small businesses had to pay Obamacare’s mandated penalty.

A mandated penalty was avoided if people worked less than 29 hours a week. Therefore, large employers reduced full time jobs to part time.

There are many other reasons that Obamacare has failed. It has inhibited economic growth.

Obamacare must be completely repealed.

The Ryan plan’s process is repealing as much of Obamacare as it can through the reconciliation process. This is only the first stage. does.

After passage of the American Healthcare Act, Dr. Tom Price will then move on to part two.

He will repeal all the administrative rules and regulations that President Obama and Donald Berwick put in place that hurt Americans and the economy.

He will replace them (one regulation for two eliminated) that will help people obtain affordable healthcare insurance and help our economy grow.

Republicans opposed to the Ryan plan do not seem to get this point.

If Republicans could get total repeal through the House of Representatives with they would not get the 60 votes necessary to get Senate approval.

In stage three Republicans will be able to get the 60 votes necessary for Senate approval.

There are 18 vulnerable Democratic senators up for reelection in 2018.

With Obamacare’s rules and regulations repealed at that time, Democrats’ opposition to things like expanded Health Savings Accounts, malpractice Reform, insurance Reform and insurance across state lines will melt. It will be important for these vulnerable Democrats to vote for these reforms in order to get reelected..

The Ryan plan now looks like an excellent strategy to me. I do not see why the opposition Republicans cannot see it.

Doing it their way with complete repeal a stage one might not work. Then will be stuck with Obamacare and the loss of both Republican controlled of the house and senate in 2018.

There are still refinements necessary to be a consumer driven healthcare plan that is patient-centered.

I hope the Ryan/Price plan is passed by congress.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

The bill continues to allow the government and the healthcare insurance companies to drive the cost and the healthcare system.

The Republican bill does not provide incentives for consumers to use their healthcare dollars wisely.

It does not include malpractice reform.

If President Trump buys the nonsense Republicans are calling a repeal and replacement for Obamacare, then the RINO’s have pulled the wool over his eyes.

It would be a gigantic mistake to push this bill in its present form. You would be producing political capital for the politically bankrupt Democrats.

This bill is a typical bait and switch. Rand Paul is correct. It is Obamacare lite.

It does not put consumers in charge. It keeps the healthcare insurance industry in full control of medicine, healthcare and the government.

Rather than discontinuing an entitlement it creates another one.

Refundable tax credit is another term for redistribution of wealth. You give money to everyone. You then take it back from some and let the others have it.

It does not repeal most of the Obamacare regulations.

It extends many of the programs past 2019.

President Trump, it does not help drain the swamp as you promised. It makes the swamp worse.

The insurance companies are not returned to a free market. It is a clever way to support the insurance companies by switching from a mandate and penalty to a tax credit (giving the money away to everyone).

This is another entitlement to further enrich the healthcare insurance industry.

Americans elected these Republican politicians to drain the swamp. This bill is no different than Obamacare.

“Refundable” tax credits – for those who don’t owe taxes – are still a subsidy. It is still redistribution of wealth, with winners (those who get the subsidy) and losers (those who pay for it). And the chief winner is the “health plan.” It gets money; the supposed beneficiary may get nothing, or only rationed care from a narrow network.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/03/profoundly-disappointed.htmlWho Is Tom Price M.D. ?tag:typepad.com,2003:post-6a00d83451876469e201b8d267bc95970c2017-03-06T11:21:25-06:002017-03-06T11:28:35-06:00Stanley Feld M.D.,FACP,MACE Tom Price M.D. is an Atlanta orthopedic surgeon who had practice orthopedic surgery in a group at Emory University Medical School and who had been active in the Georgia medical Association. “Thomas Edmunds "Tom" Price (born October...stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

Tom Price M.D. is an Atlanta orthopedic surgeon who had practice orthopedic surgery in a group at Emory University Medical School and who had been active in the Georgia medical Association.

It is trying to generate doubt about the wisdom of his replacement bill for Obamacare with the following statements that the public doesn’t understand.

2. He will force reimbursement tied to outcomes and related value-based models.

3. He wants doctors in control of the healthcare system

4. He wants tort reform.

5. He wants doctors paid from insurers with fewer hurdles and less barriers.

The healthcare insurance companies are terrified of the abbreviated blueprint. The blueprint represents a threat to the healthcare insurance industry’s power over the healthcare system in both the government and the private insurance sectors.

The mainstream media is babbling about a lack of harmony in the Republican Party. In the next few weeks we are going to hear how disorganized the Republicans in congress are.

Democrats claim the Republicans do not have anything better than Obamacare. They are starting to make up stories about what the Republicans do or do not have. Everything is designed to make the public nervous about President Trump and his administration. These stories are parroted by the Democrat’s ally, the mainstream media.

Meanwhile, the Democrats, the mainstream media, and the public do not know what will be in the replacement act after Obamacare is repealed.

President Trump. Paul Ryan and Tom Price know if all the details are released now most of it would be attacked out of context by the mainstream media.

The Democrats’ goal would be to make the public uncertain about the Republican replacement bill. The Democratic ally, the mainstream media, is all ready spreading the misinformation about the replacement without knowing what is in it.

I even saw a poll published in the mainstream media that said more people like Obamacare than don’t like it.

This is a fake poll. It does not represent the sentiment of the majority of the people.

The political chicanery on the part of the Democrats and the biased mainstream media can be overwhelming.

I do not think the political chicanery is going to overwhelm the public, President Trump or Paul Ryan. I believe they have figured out the Democrats and the media.

Some Republicans have a slightly different opinion on how Obamacare should be replaced. Political action groups oppose some of the methodology being used to replace Obamacare.

“They also are deeply opposed to a commitment to temporarily maintain an expanded form of Medicaid, as numerous GOP governors are demanding.”

Paul Ryan is trying to transition out of Obamacare so that the 11 million new Medicaid patients and the 9 million Obamacare patients do not lose their insurance as the new Republican plan is put in place. Someone does not understand the word temporary.

Several in congress want immediate repeal and replacement. I believe this will give the Democrats more fuel for the fire to subvert anything Republicans are trying to accomplish.

“To the extent that they’re doing something else with this plan other than full repeal, the concerns that conservatives in the House are expressing are completely valid,” said Michael Needham, chief executive of Heritage Action.”

It is important to remember that190 million Americans and their families receive healthcare insurance from their employers. Obamacare has negatively affected employers. The increases in costs, access, deductibles and coverage provided by employers have negatively impacted employees.

Both are demanding relief. These people, at town hall meetings, have made it clear to the Republican congressmen and Senators not to slow down Paul Ryan and President Trump. They want relief and they want it fast.

I believe President Trump will help Paul Ryan get a bill through congress that will provide relief for the entire population.

Hopefully, they have included some of my suggestions.

I am certain that Republicans will work out their differences before they present the bill to the people and the congress.

It the meantime I would suggest that Republics and Democrats keep the noise of the demagoguery down.

The United States of America desperately needs a financially sustainable healthcare system that will provide everyone with access to affordable healthcare.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/03/tom-price-md-is-an-atlanta-orthopedic-surgeon-who-had-practice-orthopedic-surgery-in-a-group-at-emory-university-medical-sc.htmlWhat Is Patient-Centered Healthcare?tag:typepad.com,2003:post-6a00d83451876469e201b7c8db7bf4970b2017-03-01T11:30:45-06:002017-03-01T11:30:45-06:00Stanley Feld M.D.,FACP, MACE Patient-Centered Healthcare is a new buzz phrase. It has become popular among Republicans in the last few years. I have a feeling most people do not know what physicians mean by patient-centered healthcare. The true definition...stanleyfeldmdmace

I have a feeling most people do not know what physicians mean by patient-centered healthcare.

The true definition is that patients are in the center of the medical care interaction. Patients determine their needs and their physicians. Patients drive the medical encounter. Neither the government nor the insurance industries drive the medical encounter.

A fatal floor in Obamacare was that President Obama wanted the federal government to control the healthcare system.

President Trump’s goal is to have patients in control of their own health and healthcare dollars. It is not a problem if the government or employers provide those healthcare dollars.

I believe Tom Price M.D. understands that the only system that will work is a system in which the consumers (patients) are responsible for their own health and healthcare dollars.

The government’s job is to provide incentives in the healthcare system for consumers to become responsible for their health and healthcare dollars.

I am not at all sure the Republican congressional leadership understands the definition or value of patient- centered care.

Obamacare provided just the opposite. Obamacare provided incentives for consumers/patients to be dependent of government.

This fundamental tenet of patient-centered care was tested by Stewart, et.al. in 2000.

Experts studied audio taped doctor-patient interactions while patients also rated these same interactions.

Expert opinion could not be correlated with positive results, but patient-perceived patient-centered care correlated with “better recovery from their discomfort and concern, better emotional health.

Most of the Republicans are talking about patient centered healthcare. However, they start and end with Health Savings Accounts and Consumer Driven Healthcare.

The American Association of Clinical Endocrinologist defined patient-centered healthcare in its diabetes guidelines of 1996 and 2002. (on request)

The guidelines were a System of Intensive Self-Management of Type 2 Diabetes Mellitus.

The Type 2 Diabetic was taught to become a “professor of his/her diabetes.”

The goal was to get the diabetic blood sugar as close to normal as possible. It was shown that normalizing the blood sugar helped avoided the vascular complication of diabetes. The treatment of the vascular complications of diabetes absorbed 80% of the money spent on diabetes.

Patients live with their disease 24/7. Blood sugars are very variable. Patients need to learn how to adjust to these variables by managing their medications and lifestyle.

Patients taking a pill or a shot will not control their blood sugar unless they understand the medication and how to adjust it to have the greatest affect on the blood sugar.

The only way a patient can understand how to control their blood sugar is for them to understand how their blood sugar affects the effectiveness of the medication and how their medications and lifestyle affects their blood sugar.

This same phenomenon applies to most chronic diseases.

The only way to decrease the complications of chronic diseases is for patient to drive the treatment of their disease.

This in turn will be the only way to control healthcare costs. This is what I mean when I say patients should be in control of their health.

As an added incentive to control costs, patients should be in control of their healthcare dollars so they figure out how to use medication most affectively.

“In 2001, The Institute of Medicine published a book called Crossing the Quality Chasm: A New Health System for the 21st Century.”

“In it, the institute identified six aims for improvement of healthcare delivery, one of which was “patient-centered care,” defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

The Institute of Medicine’s definition moves patients’ needs and attitudes toward patients being in the center of care. It does not place them as responsible for the management of their care. It does not include patients’ responsibility for their care.

All four of the endocrinologists got close to the definition of patient centered care. Only Carol Greenlee, MD, FACE, FACP, of Western Slope Endocrinology in Grand Junction, Colorado nailed the definition. Dr. Greenlee is the only physician in private practice.

She said:

“One of the most important things is partnership with the patient and what is called “contextualized” care, which means taking into account a patient’s needs and circumstances, goals and values.

It is also called developing a physician/patient relationship.

Another aspect is moving from the physician being at the center of the care model, with staff working to help the physician (doing tasks for the physician or other clinician such as “rooming” the patient or “scheduling” the patient for the clinician) to the staff also “taking care of the patient” as their job, with different roles on the patient-centered care team (getting the patient in for a needed appointment).

It is doing what is best for the patient (not giving the patient what they want, e.g. pain meds, MRI, antibiotics) or ask for (those things are not often best for the patient, but takes time to discuss through).

It’s taking our best science and knowledge and technology and then adapting it to meet the patient’s unique needs, circumstances, values, and goals.

It requires clearing up misconceptions (such as asking what the patient currently understands about a condition or a test or treatment), helping discuss risks and benefits in the context of that individual patient.

It requires asking not just telling, but it is not dumping everything back on to the patient.

It is taking into account the “work” (the job) of care (self-care that the patient or family need to do) on top of the illness and the rest of life that the patient and their family have to deal with and do (i.e. consideration)

Most clinicians think that they are already patient-centered because they care about their patients.

But that does not mean they provide patient-centered care or practice in a patient-centered approach.

I thought I was patient-centered because I cared but then I had to uproot my mental model to really become patient-centered.”

Republicans and their advisors do not understand the meaning of the concept of patient centered care.

Tom Price M.D. understands the concept of patient centered care.

Without the patient being in the center of the management of his/her care, the healthcare system can never be repaired and will never be financially sustainable.

I hope President Trump gets the concept in spite of the advice from congressional Republican and Democrats. Congress is trying to satisfy all the secondary vested interests. Healthcare is a big business with many secondary stakeholders. They do not want to lose this important profit center.

These stakeholders are better organized than patients or physicians to influence healthcare policy makers.

The primary stakeholders are patients with their head coaches and assistant coaches being physicians and their healthcare team.

Patients must be in the center of the healthcare team because they are the only ones that can influences the cost of medical care.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2017/03/what-is-patient-centered-healthcare.htmlListen Up: It Is All About Personal Responsibilitytag:typepad.com,2003:post-6a00d83451876469e201b8d2618221970c2017-02-17T10:50:53-06:002017-02-17T10:50:53-06:00Stanley Feld M.D.,FACP,MACE In my last blog I continued my War on Obesity. I started this war in 2007. There has been little progress in this war because of cultural conditioning and a lack of emphasis on personal responsibility. Every...stanleyfeldmdmace

Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater.

A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women.

With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8)

These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease.

Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy.

Eighty percent of the treatment costs for diabetes and hypertension to the healthcare system is the result of the treatment of the complications of hypertension and diabetes.

In order for a healthcare system to be sustainable diabetes and hypertension must be cured. It is essential that each must be recognized early and treated aggressively.

Equally important is the morbidity resulting from the complications of diabetes and hypertension, two diseases that result from obesity.

Complications from the onset of both hypertension and diabetes take about eight years to develop. This is the reason to diagnose and discover Pre-Diabetes at the onset.

The shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for non-pharmacological intervention.

Thus, the initial approach to the management of bothdiabetes and hypertension must emphasize weight control, physical activity, and dietary modification.

Lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders.

This is the where my story of the importance of personal responsibility comes in.

A restaurateur, in his early 50’s, who runs a large restaurant in Dallas, that I frequent, was slowly gaining weight. At 269 lbs. he had difficulty standing on his feet all day long. He was being treated for hypertension and hyperlipidemia (high cholesterol).

His physician told him he must lose weight. He informed him of his risk factors for the complications of these diseases.

This was all he needed hear. The thought of having to quit the job he loved and the possibility of dying from the complications of his diseases was enough to make him decide to loss the weight.

He was told he would be fine if he lost the weight.

He has lost 70 lbs.so far without assistence. He has decided to be personally responsible for his weight loss.

He now gets up at 5 am each morning and exercises for one hour each day before work.

He has stopped eating his wonderful pasta dishes. He eats nothing that is white.

Every time I meet a friend at the restaurant, the restaurateur sits down at our table for a chat. We usually talk about how great he is doing in the weight loss department.

I had initiated an obesity program at Endocrine Associates of Dallas P.A. in the mid 1980s. A California clinical endocrinologist, with whom I did my endocrine fellowship with, had a very successful obesity program. He convinced me to start one at EAD.

Patients on large doses of insulin were totally off insulin after two weeks. It was successful until the patients graduated from the program.

Unfortunately the recidivism rate (regaining weight) was around 80%. This rate was not dissimilar to the national overage at the time.

EAD stopped the program.

In my view there were not enough patients who turned the corner and stuck to the program.

I believe the restaurateur has turned the corner. This fellow has turned the personal responsibility corner to control his food intake and exercise output. I do not believe he will regain his weight.

He has exhibited personal responsibility for his health and well-being.

If only physicians could solve the obesity problem so easily, the cost of healthcare would plummet to sustainable levels.

The development of Type 2 Diabetes Mellitus would also plummet and the cost of the treatment of its complications would vanish.

Social change is necessary in restaurants and fast food chains.

People have to be taught to eat wisely in restaurants and at home.

People have to be provided with education about the perils of obesity.

People have to understand the natural history of obesity.

People have to be motivated to not only maintain their health. They have to be given financial incentives to control their health.

This can only be achieved with a consumer driven healthcare system in which people are provided with incentives to control their healthcare dollars.